Mrs Mary Fuller, DNP is a medicare enrolled "Nurse Practitioner" physician in Kewanee, Illinois. She graduated from medical school in 2019 and has 5 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice County Of Henry and her current practice location is
110 N Burr Blvd, Kewanee, Illinois. You can reach out to her office (for appointments etc.) via phone at
(309) 852-0197.
Mrs Mary Fuller is licensed to practice in Illinois (license number 209021513) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1497364053.
Physician's Profile
| Full Name | Mrs Mary Fuller |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 5 Years |
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| Location | 110 N Burr Blvd, Kewanee, Illinois |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mrs Mary Fuller graduated from medical school in 2019
NPI Data:
- NPI Number: 1497364053
- Provider Enumeration Date: 07/29/2020
- Last Update Date: 08/04/2020
Medicare PECOS Information:
- PECOS PAC ID: 4082033642
- Enrollment ID: I20200930002898
Medical Identifiers
Medical identifiers for Mrs Mary Fuller such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1497364053 | NPI | - | NPPES |
| 366006568001 | Medicaid | IL | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 2083P0901X | Preventive Medicine - Public Health & General Preventive Medicine | 209021513 (Illinois) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | 209021513 (Illinois) | Secondary |
| 363L00000X | Nurse Practitioner | 209021513 (Illinois) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| County Of Henry | 5193828556 | 7 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Mary Fuller allows following entities to bill medicare on her behalf.
| Entity Name | County Of Henry |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1851394829
PECOS PAC ID: 5193828556
Enrollment ID: O20070306000229 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Mary Fuller is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mrs Mary Fuller, DNP
110 N Burr Blvd,
Kewanee, IL 61443-2214
Ph: (309) 852-0197 | Mrs Mary Fuller, DNP
110 N Burr Blvd,
Kewanee, IL 61443-2214
Ph: (309) 852-0197 |
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