Anna R Fullmer, MSSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6573-123 Issued in WI

Practice address

400 S Townline Rd
Wautoma, WI 54982-6922

Phone

(920) 787-5514

NPI assigned

May 13, 2006

Last updated

Jun 13, 2024By the provider in NPPES

Sex

Female

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

Other names 1

• Barbara J Fullmer Former name

Medicare fee-for-service enrollment

Enrolled in WI

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 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• La Clinica de Los Campesinos, Inc

  dba Noble Community Clinics

  • Federally Qualified Health Center (FQHC)
  • Stevens Point, WI
  • NPI 1790786929
  Medicare reassignment NPD
• La Clinica de Los Campesinos, Inc

  • Pharmacy
  • Wautoma, WI
  • NPI 1174322846
  NPD

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1306897467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S TOWNLINE RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549826922",
            "telephone_number": "920-787-5514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S TOWNLINE RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549826922",
            "telephone_number": "920-787-5514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLMER",
        "first_name": "ANNA",
        "middle_name": "R",
        "credential": "MSSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-13",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "6573-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39797500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BARBARA",
            "last_name": "FULLMER",
            "middle_name": "J",
            "credential": "MSSW, LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Forefront Dermatology, S.C.
• Eric Foss, RPH
• Joan L. Fox, DDS
• Ann Loretta Frintner, CSAC CADC III
• Julie Alice Froehlich, RN
• Tammy Luella Gagnon, PTA
• Alissa Gies, PHARMD
• Karisa Nicole Gloudemans, DPT
• Golden Sands RCS
• Golden Sands RCS Inc

• Clinical Social Worker in Wautoma, WI
• Providers in Wautoma, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.