NPIMap

Individual provider Active NPI

Melissa A Fullner-Marshall, PA

  • Medical Physician Assistant
  • Yankton, SD
National Provider Identifier
1407033012
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1222 Issued in SD
Practice address
1104 W 8TH St
Yankton, SD 57078-3306
Phone
(605) 665-7841
Fax
(605) 665-0546
NPI assigned
Jan 25, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1632 NE
Medical Physician Assistant 363AM0700X 0667 SD
Medical Physician Assistant 363AM0700X 1222 SD Primary

Addresses

Primary practice location

1104 W 8TH St
Yankton, SD 57078-3306

Mailing address

1104 W 8TH St
Yankton, SD 57078-3306
Phone (605) 665-7841

Other identifiers 2

IdentifierTypeStateIssuer
10025938900MedicaidNE
6830000MedicaidSD

Other names 1

  • Melissa A Fullner Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmarshall@direct.yanktonmedicalclinic.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080303000195 SD Practitioner - Physician Assistant 5496839383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

2601 Fox Run Pkwy
Yankton, SD 57078-5341
Phone (605) 668-8850

300 W 5TH St
Miller, SD 57362-1238
Phone (605) 853-0158

310 S Penn St
Aberdeen, SD 57401-4553

501 Summit St
Yankton, SD 57078-3855
Phone (605) 668-8000

Hospital & facility affiliations

  • Avera Sacred Heart Hospital Hospital, Yankton, SD, CCN 430012
  • Avera McKennan Hospital & University Health Center Hospital, Sioux Falls, SD, CCN 430016
  • St Michael'S Hospital - Cah Hospital, Tyndall, SD, CCN 431327
  • Avera Gregory Hospital Hospital, Gregory, SD, CCN 431338
  • Avera St Benedict Health Center - Cah Hospital, Parkston, SD, CCN 431330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1632NEMDMental Health Counselor
1222SDMDObstetrics & Gynecology Physician
0667SDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Dec 1, 2023 Accepting new patients
Avera McKennan CurrentSince Dec 1, 2023 Accepting new patients
Avera McKennan Past Accepting new patients
Avera St Anthonys Hospital Past Accepting new patients
Sacred Heart Health Services Past Accepting new patients

Locations

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

300 W 5th St
Miller, SD 57362
Phone (605) 853-0158

1000 E 23rd St
Ste 230
Sioux Falls, SD 57105
Phone (605) 322-6900

1104 W 8th St
Yankton, SD 57078
Phone (605) 665-7841

501 Summit St
Yankton, SD 57078
Phone (605) 655-1201

501 Summit St
Ste 410
Yankton, SD 57078
Phone (605) 655-1810

Interoperability endpoints

  • Direct secure messaging: melissa.fullnermarshall@avera.sdhealthlink.net

Organizations & group practices 6

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.

Hospital & facility affiliations 32

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1201219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1407033012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 W 8TH ST",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570783306",
            "telephone_number": "605-665-7841",
            "fax_number": "605-665-0546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 W 8TH ST",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570783306",
            "telephone_number": "605-665-7841",
            "fax_number": "605-665-0546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLNER-MARSHALL",
        "first_name": "MELISSA",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-25",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NE",
            "license": "1632",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SD",
            "license": "0667",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SD",
            "license": "1222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025938900",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6830000",
            "state": "SD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmarshall@direct.yanktonmedicalclinic.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1104 W 8th St",
            "city": "Yankton",
            "state": "SD",
            "country_code": "US",
            "postal_code": "570783306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "FULLNER",
            "middle_name": "A",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Yankton, SD

Sources for this page

Verify at the official NPI Registry.