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SAMANTHA ELLEN FULLMER
NPI 1265031496
Nurse Practitioner - Family in Mesa, AZ

Active since October 19, 2020PECOS EnrolledAccepts Medicare Assignment
1705 W MAIN ST, MESA, AZ 85201(480) 964-2273(480) 718-9477 Get Directions Write a Review

NPPES record last updated: May 3, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 3, 2023, Aug 5, 2022, Oct 19, 2020 (3 updates tracked since 2020).

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

NPI1265031496
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameSAMANTHA ELLEN FULLMER
Location Address1705 W MAIN STMesa, AZ 85201-6920
Mailing Address3033 N Central Ave Ste 145Phoenix, AZ 85012-2808 · (623) 583-3001 · Fax (623) 974-6721
Phone(480) 964-2273
Fax(480) 718-9477
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateOctober 19, 2020
Last NPPES UpdateMay 3, 20233 updates tracked since enumeration
NPPES CertifiedMay 3, 2023
✔ NPI 1265031496 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in AZ · 223113
Also ListedGeneral PracticeTaxonomy 208D00000X · License 223113 (AZ)
1705 W MAIN ST, Mesa, AZ 85201
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Blue Cross Blue Shield of Arizona, Imperial Insurance Companies, Inc. and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

PECOS PAC ID5698153005
PECOS Enrollment IDI20220525001930
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

ADELANTE HEALTHCARE, INC
Community/Behavioral Health
1705 W MAIN ST
MESA, AZ 85201
Maricopa County (480) 964-2273
MARIE V KHATINHA FNP- BC
Nurse Practitioner (Family)
1705 W MAIN ST
MESA, AZ 85201
Maricopa County (480) 964-2273
RYAN ELISABETH ROMO
Family Medicine
1705 W MAIN ST
MESA, AZ 85201
Maricopa County (877) 809-5092
ROBERT ELK M.D.
Internal Medicine
1705 W MAIN ST
MESA, AZ 85201
Maricopa County (877) 809-5092
MS. KRISTEN M RIHAWI NP
Nurse Practitioner (Family)
1705 W MAIN ST
MESA, AZ 85201
Maricopa County (877) 809-5092
DR. KAREEM BANNIS M.D.
Internal Medicine (Geriatric Medicine)
1705 W MAIN ST
MESA, AZ 85201
Maricopa County (480) 964-2273
MS. MICHELLE FALCON
Social Worker
1705 W MAIN ST
MESA, AZ 85201
Maricopa County (877) 809-5092
JESSICA MCKINNON WHNP-BC
Nurse Practitioner (Women's Health)
1705 W MAIN ST
MESA, AZ 85201
Maricopa County (480) 964-2273

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.

What insurance does Samantha Fullmer accept?

Health plans from Ambetter from Arizona Complete Health, Blue Cross Blue Shield of Arizona, Imperial Insurance Companies, Inc., Oscar Health Plan, Inc. and UnitedHealthcare 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.