Michael Carl Fusco, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

R3H26 Issued in MO

Practice address

14528 S Outer 40
Suite 300
Chesterfield, MO 63017-5785

Phone

(314) 214-8100

Fax

(314) 214-8233

NPI assigned

Jan 26, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Clear Practice PLLC

  • Clinic/Center
  • Creve Coeur, MO
  • NPI 1386498319
  NPD
• Granite City Clinic Corp

  • Certified Registered Nurse Anesthetist
  • Granite City, IL
  • NPI 1003892464
  NPD (past)
• Granite City Clinic Corp

  • Family Medicine Physician
  • Granite City, IL
  • NPI 1255387957

  Internal Medicine

  NPD (past)
• Granite City Physicians Corp

  • Clinical Medical Laboratory
  • Granite City, IL
  • NPI 1508983214
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003962481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14528 S OUTER 40",
            "address_2": "SUITE 300",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175785",
            "telephone_number": "314-214-8100",
            "fax_number": "314-214-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14528 S OUTER 40",
            "address_2": "SUITE 300",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175785",
            "telephone_number": "314-214-8100",
            "fax_number": "314-214-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSCO",
        "first_name": "MICHAEL",
        "middle_name": "CARL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R3H26",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "333410L",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Fritz, RN, PHD, FNP
• Joseph Michael Fritz, M.D.
• Michael F Frossard Jr., MPT
• Melinda Fry, L.P.C.
• Full Circle Home Care Missouri, LLC
• FV at Home - Home Health, LLC
• G Patrick O'Donnell M.D.
• Moataz M Gaddor, MD
• Monica Gainer
• Nicole L. Gaines, MSW, LCSW

• Internal Medicine Physician in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.