Clark J Fullmer Ii, DPM is a medicare enrolled "Podiatrist - Foot & Ankle Surgery" provider in Dickinson, North Dakota. He went to California School Of Podiatric Medicine and graduated in 1995 and has 29 years of diverse experience with area of expertise as Podiatry. He is a member of the group practice Omaha Therapy Inc, Sanford Bismarck and his current practice location is
2615 Fairway St, Dickinson, North Dakota. You can reach out to his office (for appointments etc.) via phone at
(701) 456-6000.
Clark J Fullmer Ii is licensed to practice in North Dakota (license number 60) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1649240557.
Healthcare Provider's Profile
| Full Name | Clark J Fullmer Ii |
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| Gender | Male |
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| Speciality | Podiatry |
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| Experience | 29 Years |
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| Location | 2615 Fairway St, Dickinson, North Dakota |
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| Accepts Medicare Assignments | Yes. He 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:
- Clark J Fullmer Ii attended and graduated from California School Of Podiatric Medicine in 1995
NPI Data:
- NPI Number: 1649240557
- Provider Enumeration Date: 01/24/2006
- Last Update Date: 08/30/2018
Medicare PECOS Information:
- PECOS PAC ID: 4981708567
- Enrollment ID: I20100127000303
Medical Identifiers
Medical identifiers for Clark J Fullmer Ii such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1649240557 | NPI | - | NPPES |
| 14953 | Medicaid | ND | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 213ES0103X | Podiatrist - Foot & Ankle Surgery | 60 (North Dakota) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Omaha Therapy Inc | 1557270915 | 41 |
| Sanford Bismarck | 9739098575 | 457 |
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. Clark J Fullmer Ii allows following entities to bill medicare on his behalf.
| Provider Name | Sanford Bismarck |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1811941172
PECOS PAC ID: 9739098575
Enrollment ID: O20031105000403 |
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| Provider Name | Sanford Bismarck |
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| Provider Type | Part B Supplier - Ambulatory Surgical Center |
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| Provider Identifiers | NPI Number: 1598185597
PECOS PAC ID: 9739098575
Enrollment ID: O20040304000249 |
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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. Clark J Fullmer Ii 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 |
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Clark J Fullmer Ii, DPM
2615 Fairway St,
Dickinson, ND 58601-2590
Ph: (701) 456-6000 | Clark J Fullmer Ii, DPM
2615 Fairway St,
Dickinson, ND 58601
Ph: (701) 456-6000 |
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