{"npi":"1174569107","type":"NPI-1","status":"active","name":{"display":"Dr. Gregory Fuller D.O.","other":[],"first":"GREGORY","last":"FULLER","middle":"W","credential":"D.O."},"specialty":{"primary_taxonomy":"207P00000X","primary_taxonomy_description":"Emergency Medicine","slug":"emergency-medicine","schema_org_specialty":"Emergency","all":[{"code":"207PE0004X","description":"Emergency Medical Services (Emergency Medicine) Physician","primary":false,"state":"MI","license":"012543"},{"code":"207Q00000X","description":"Family Medicine","primary":false,"state":"FL","license":"OS5478"},{"code":"207P00000X","description":"Emergency Medicine","primary":true,"state":"MI","license":"5101012543"}]},"addresses":[{"purpose":"LOCATION","street_1":"1006 AIRPORT RD","city":"JACKSON","state":"MI","postal_code":"492021851","country_code":"US","phone":"5177846663","fax":"5177877976"},{"purpose":"MAILING","street_1":"1006 AIRPORT RD","city":"JACKSON","state":"MI","postal_code":"492021851","country_code":"US","phone":"5177846663","fax":"5177877976"}],"license":{"state":"MI","number":"5101012543"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"114545400","state":"MI","issuer":null},{"type_code":"01","label":"Other","value":"GF012543","state":"MI","issuer":"BLUE SHIELD"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20040128001055","type_code":"14-93","type_desc":"PRACTITIONER - EMERGENCY MEDICINE","state":"MI","pac_id":"2062315948"},{"enrlmt_id":"I20241112004506","type_code":"14-93","type_desc":"PRACTITIONER - EMERGENCY MEDICINE","state":"FL","pac_id":"2062315948"}]},"enumeration_date":"2006-06-20","last_updated":"2021-09-23","_meta":{"source":"NPPES","snapshot_date":"2021-09-23","doc_url":"https://findmynpi.com/api"}}