Individual provider Active NPI

Weston Drew Fulmer, DMD

  • General Practice Dentistry
  • Nevada, MO
National Provider Identifier
1801585153
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2023020608 Issued in MO
Practice address
301 W Austin Blvd
Nevada, MO 64772-3124
Phone
(844) 853-8937
NPI assigned
May 3, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2023020608 MO Primary

Addresses

Primary practice location

301 W Austin Blvd
Nevada, MO 64772-3124

Mailing address

1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131

Other practice location 1

21523 S 156th St
Gilbert, AZ 85298-9599
Phone (480) 754-9888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230609000207 MO Practitioner - Dentist 9537526389 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2023020608MOMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Compass Health, Inc CurrentSince Jun 26, 2023 Accepting new patients
Compass Health, Inc CurrentSince Jun 26, 2023 Accepting new patients

Locations

1800 Community
#B
Clinton, MO 64735

1800 Community
Clinton, MO 64735
Phone (660) 885-8131

301 W Austin Blvd
Nevada, MO 64772

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1683072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1801585153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COMMUNITY",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647358804",
            "telephone_number": "660-885-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W AUSTIN BLVD",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647723124",
            "telephone_number": "844-853-8937"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21523 S 156th St",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852989599",
            "country_code": "US",
            "telephone_number": "480-754-9888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULMER",
        "first_name": "WESTON",
        "middle_name": "DREW",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-03",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2023020608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nevada, MO

Sources for this page

Verify at the official NPI Registry.