SAMANTHA ELLEN FULLMER
NPI 1265031496
Nurse Practitioner - Family in Mesa, AZ
About Samantha Ellen Fullmer NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMANTHA ELLEN FULLMER (NPI 1265031496) is an individual family provider in Mesa, Arizona, licensed in Arizona (223113) and active in the NPI registry since October 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Samantha Ellen Fullmer is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Samantha Fullmer reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Mesa, AZ 85201
- Reassigned Medicare billing, Arizona enrollment
- 234 clinicians in this Medicare group
Mesa, AZ 85209
- Reassigned Medicare billing, Arizona enrollment
- 5 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 85201 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Samantha Fullmer's NPI number?
The NPI number for Samantha Fullmer is 1265031496. It was assigned to this individual provider in the NPPES registry on October 19, 2020.
Where is Samantha Fullmer located?
Samantha Fullmer practices at 1705 W Main St, Mesa, AZ 85201. The listed phone number is (480) 964-2273.
What is Samantha Fullmer's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Samantha Fullmer enrolled in Medicare?
Yes. Samantha Fullmer is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Samantha Fullmer's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samantha Fullmer reassigns Medicare benefits to 2 organizations: Adelante Healthcare, Inc. (Mesa, AZ) and Goldfield Medical Clinics, LLC (Mesa, AZ). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samantha Fullmer's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Samantha Fullmer accept?
Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Blue Cross Blue Shield of Arizona, Cigna HealthCare of Arizona, Inc and Imperial Insurance Companies, Inc. and 2 other insurers list Samantha Fullmer as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Samantha Fullmer was last updated on May 3, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Samantha Ellen Fullmer · NPI 1265031496
Family physician in Mesa, Arizona. Individual provider, active in the CMS NPPES registry since October 19, 2020.
## Identity
- **NPI:** 1265031496 (Entity type: Individual)
- **Enumerated:** October 19, 2020
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 223113 (Arizona)
- **Sole proprietor:** No
## Practice location
- **Address:** 1705 W MAIN ST, Mesa, AZ 85201-6920
- **Phone:** (480) 964-2273 · **Fax:** (480) 718-9477
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Adelante Healthcare, Inc. (NPI 1891853446, Mesa, AZ); Goldfield Medical Clinics, LLC (NPI 1861412686, Mesa, AZ) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** May 3, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1265031496) · Data from the CMS NPPES public registry.