Adam K Fuller, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

306 Issued in WY

Practice address

191 Overthrust Rd
Evanston, WY 82930-9261

Phone

(435) 631-9918

NPI assigned

Feb 20, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WY, UT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• High Desert Psychology and Wellness

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Evanston, WY
  • NPI 1194226266

  UT

  Medicare reassignment NPD Authorized official
• Novum Psychotherapy, PC

  • Psychologist
  • Salt Lake City, UT
  • NPI 1437666054
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522281600000",
    "number": "1255476131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 HAYDEN AVE",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305606",
            "telephone_number": "435-631-9918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 OVERTHRUST RD",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829309261",
            "telephone_number": "435-631-9918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2078 Prospector Ave",
            "address_purpose": "LOCATION",
            "city": "Park City",
            "state": "UT",
            "postal_code": "840607321",
            "country_code": "US",
            "telephone_number": "435-631-9918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "ADAM",
        "middle_name": "K",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2018-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WY",
            "license": "306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118774100",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yuri Edna Freeman, MA
• Teresa Frey
• Charlotte Fry
• Crystal Dawn Fry
• Rolando Arturo Fuentes
• Pamela R Fuller, PHD
• Lidia E Garcia
• Nena M. Germany-Greer, MA, CCC-SLP
• Colby Kim Gomez, DPT
• Alyssa Joanne Gonshorowski, LPC

• Clinical Psychologist in Evanston, WY
• Providers in Evanston, WY by specialty
• Clinical Psychologist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.