Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Justin Wayne Fuller

Individual provider Certified Registered Nurse Anesthetist · NPI 1962176917

Justin Wayne Fuller is registered under Certified Registered Nurse Anesthetist (CRNA) in Mesa, Arizona. Qualified in 2021, 5 years ago. Practices with Banner Hospital Based Physicians Arizona LLC, a 641-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
5
Licensed in
AZ
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

1400 S Dobson Rd
Mesa, AZ 85202-4707
Phone: (972) 761-5508
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 264564 (AZ)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence RN185391 (AZ)

Record details

NPI number1962176917
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 3, 2021
Last updated in NPPESSeptember 29, 2026
Certification dateOctober 26, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Banner Hospital Based Physicians Arizona Llc — 641 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients63
Services billed 66 a service is one billed item, such as a visit, a test or a procedure
Average patient age73

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at Banner Hospital Based Physicians Arizona LLC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 641 clinicians in the practice; 12 are shown here.

Other providers in Mesa