Marcel Fomotar, CRNP-PMH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95014417 Issued in CA

Practice address

1085 Sanders Ave
Clovis, CA 93619-3935

Phone

(408) 449-6623

NPI assigned

Dec 12, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, CA2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

University of South Alabama College of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Imperial Psychiatric Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Salisbury, MD
  • NPI 1780184564

  MD, Psychiatric/Mental Health

  Medicare reassignment NPD
• Body and Mind Healthcare Services - a Nursing Corporation

  • Psychiatric/Mental Health Nurse Practitioner
  • Clovis, CA
  • NPI 1700568078

  CA

  Medicare reassignment

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

{
    "created_epoch": "1513036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1447765409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 SANDERS AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936193935",
            "telephone_number": "408-449-6623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1085 SANDERS AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936193935",
            "telephone_number": "408-449-6623"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 E Naylor Mill Rd Unit F",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218042256",
            "country_code": "US",
            "telephone_number": "410-572-4738",
            "fax_number": "410-572-4649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOMOTAR",
        "first_name": "MARCEL",
        "credential": "CRNP-PMH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-12",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95043929",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R244114",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95014417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zarai Flores
• Lashaunda Floyd, LVN
• Fogg Remington Eyecare, Inc.
• Fogg Remington Eyecare, Inc.
• Stephanie M Folgar Jimenez
• Leo L. Fong, MD
• Footsteps Behavioral Health Corporation
• Footsteps, a Licensed Clinical Social Worker Corporation
• Scott Christopher Ford, MD
• Foreno Inc

• All providers in Clovis, CA
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; 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.