Dr Samuel W Fongang, - Medicare Nurse Practitioner in Camp Verde, AZ

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Dr Samuel W Fongang, is a medicare enrolled "Nurse Practitioner - Family" in Camp Verde, Arizona. His current practice location is 1298 W Finnie Flat Rd, Camp Verde, Arizona. You can reach out to his office (for appointments etc.) via phone at (928) 639-5555.

Dr Samuel W Fongang is licensed to practice in Arizona (license number 276403) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1477211076.

Contact Information

Dr Samuel W Fongang,
1298 W Finnie Flat Rd,
Camp Verde, AZ 86322-5958
(928) 639-5555
Not Available

Map and Direction




Provider's Profile

Full NameDr Samuel W Fongang
GenderMale
SpecialityNurse Practitioner - Family
Location1298 W Finnie Flat Rd, Camp Verde, Arizona
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1477211076
  • Provider Enumeration Date: 12/01/2021
  • Last Update Date: 08/21/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 3274906946
  • Enrollment ID: I20230227003083

Medical Identifiers

Medical identifiers for Dr Samuel W Fongang such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1477211076NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LF0000XNurse Practitioner - Family 65969 (New Mexico)Secondary
363LF0000XNurse Practitioner - Family 276403 (Arizona)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Samuel W Fongang allows following entities to bill medicare on his behalf.
Entity NameZion Medical Group Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1184049322
PECOS PAC ID: 1355566464
Enrollment ID: O20140703001618
Entity NameNorthern Arizona Healthcare Corporation
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1669914552
PECOS PAC ID: 3577473362
Enrollment ID: O20170801003409

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Samuel W Fongang is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Samuel W Fongang,
122 E 1700 S,
Provo, UT 84606-5644

Ph: (801) 375-5125		Dr Samuel W Fongang,
1298 W Finnie Flat Rd,
Camp Verde, AZ 86322-5958

Ph: (928) 639-5555

Reviews and Comments


Nurse Practitioner Nurses in Camp Verde, AZ

Bryan J Ebeling,
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 1298 W Finnie Flat Rd, Camp Verde, AZ 86322
Phone: 928-639-5555    
Mindy Diehl, FNP-C
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 348 S Main St, Camp Verde, AZ 86322
Phone: 928-649-6477    
Jennifer Dorn, NURSE PRACTITIONER
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 1298 W Finnie Flat Rd, Camp Verde, AZ 86322
Phone: 928-639-5555    Fax: 928-639-5554
Tiffany Witek, APNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 1298 W Finnie Flat Rd, Camp Verde, AZ 86322
Phone: 928-639-5509    
Deborah A Wasson, FNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: Yavapai-apache Health Center, 2121 W Reservation Loop Rd, Camp Verde, AZ 86322
Phone: 928-567-2168    
Jason Scott Litzinger, MSN, RNP-BC
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 1298 W Finnie Flat Rd, Camp Verde, AZ 86322
Phone: 928-350-5574    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.