Capri Mara Fillmore, MD
Individual provider Active NPI Family Medicine Physician · Arcadia, WI
NPI 1649472010 · NPPES record last updated Oct 15, 2012
Key facts
- NPI
- 1649472010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 43268 (WI)
- Practice address
- 464 S Saint Joseph Ave
Arcadia, WI 54612-1401 - Phone
- (608) 323-3341
- NPI assigned
- Jun 5, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070803000108 | TX | Practitioner - Family Practice | 9931290020 | Reassigns benefits to 1 organization |
| I20111215000892 | WI | Practitioner - Family Practice | 9931290020 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43268 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complexcare Medical Group Midwest M PLLC | Current |
Accepting new patients | |
| DHHS IHS Phoenix Area | Family Medicine | Current |
Accepting new patients |
| Theoria Medical | Current |
Accepting new patients | |
| Jicarilla IHS Pharmacy | Past |
Accepting new patients |
Locations
41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763
N7135 Rocky Knoll Pkwy
Plymouth, WI 53073
Phone (920) 449-1254
1505 Orrin Rd
Prescott, WI 54021
Phone (715) 262-1107
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 43268 | WI | Yes |
Addresses
Primary practice location
464 S Saint Joseph Ave
Arcadia, WI 54612-1401
Mailing address
464 S Saint Joseph Ave
Arcadia, WI 54612-1401
Phone (608) 323-3341
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005273601 | Other | MEDICARE PART B | |
| 8HM164 | Other | NM | PROVIDER NUMBER FOR MEDICARE |
| 91934770 | Medicaid | NM | |
| H3451 | Medicaid | NM | |
| HSZ196 | Other | NM | MEDICARE PART B |
| K3526 | Medicaid | NM |
Other providers in Arcadia, WI
- Janet W Butler
- County of Trempealeau
- Kim M Davis-Rislove
- Kaitlin S. Earley
- Christopher Ferstenou
- Holly Marie Glanville
- Mary A. Green
- Gundersen Clinic LTD
- Gundersen Clinic LTD
- Gundersen Clinic LTD
All providers in Arcadia, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.