Dustin John Fanciullo, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

14267138-1205 Issued in UT

Practice address

1160 E 3900 S Ste 3100
Salt Lake City, UT 84124-1290

Phone

(801) 262-2806

NPI assigned

Aug 21, 2008

Last updated

Mar 2, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, UT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Vascular SurgeryAlso: General Surgery

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountainstar Cardiovascular Services LLCGroup PAC ID 1951404110, 14 clinicians

Clifton Springs Sanitarium CoGroup PAC ID 5092704809, 230 clinicians

Canton-Potsdam HospitalGroup PAC ID 6204827280, 243 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rochester Regional Health Home Care Home health agency, Rochester, NY, CCN 337066
• Clifton Springs Hospital and Clinic Hospital, Clifton Springs, NY, CCN 330265
• St Mark's Hospital Hospital, Salt Lake City, UT, CCN 460047
• Rochester General Hospital Hospital, Rochester, NY, CCN 330125
• Canton-Potsdam Hospital Hospital, Potsdam, NY, CCN 330197

Merit-based Incentive Payment System (MIPS)

Final score

96.62 of 100Reported as apm

Quality

74.51

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

96.62 of 100Reported as apm

Quality

74.51

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

96.62 of 100Reported as apm

Quality

74.51

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

Interoperability endpoints

• Direct secure messaging: dfanciullo33131@direct.rochesterregional.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountainstar Cardiovascular Services LLC

  dba MountainStar Cardiovascular Surgery

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Salt Lake City, UT
  • NPI 1689721219
  Medicare reassignment Care Compare group NPD
• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782
  Medicare reassignment Care Compare group NPD
• Clifton Springs Sanitarium Co

  dba Clifton Springs Hospital and Clinic

  • General Acute Care Hospital
  • Clifton Springs, NY
  • NPI 1366505463
  Medicare reassignment Care Compare group NPD
• Gouverneur Hospital

  dba Gouverneur Hospital, Inc. Medical Professional Group

  • Critical Access Hospital
  • Gouverneur, NY
  • NPI 1295156412
  Medicare reassignment NPD
• Massena Hospital Inc

  • Critical Access Hospital
  • Massena, NY
  • NPI 1972604460
  Medicare reassignment NPD
• Rochester General Hospital

  dba Rochester General Medical Groups

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1356412712

  Vascular Surgery

  Medicare reassignment NPD
• The Unity Hospital of Rochester

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1760421713
  Medicare reassignment NPD
• Western New York Medical Practice P.C.

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1063790608

  Surgery

  Medicare reassignment NPD
• Canton-Potsdam Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Potsdam, NY
  • NPI 1114104445
  NPD
• Gouverneur Hospital

  • Critical Access Hospital
  • Gouverneur, NY
  • NPI 1629409925
  NPD
• Massena Hospital, Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Massena, NY
  • NPI 1619756640
  NPD
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1255360517

  Surgery

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northern Utah Healthcare Corporation

  dba St. Mark's Hospital

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1164469243
  Care Compare affiliation
• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782
  Care Compare affiliation
• Clifton Springs Sanitarium Co

  dba Clifton Springs Hospital and Clinic

  • General Acute Care Hospital
  • Clifton Springs, NY
  • NPI 1366505463
  Care Compare affiliation
• Genesee Region Home Care Association Inc.

  dba Rochester Regional Health Home Care

  • Home Health Agency
  • Rochester, NY
  • NPI 1801819271
  Care Compare affiliation

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

{
    "created_epoch": "1219276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772409600000",
    "number": "1013164052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 281490",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303841490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E 3900 S STE 3100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241290",
            "telephone_number": "801-262-2806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANCIULLO",
        "first_name": "DUSTIN",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-21",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "UT",
            "license": "14267138-1205",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "UT",
            "license": "14267138-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Chiropractic Health Center LLC
• Family Enrichment Services LLP
• Family Foundation Chiropractic PC (Gonstead Family Chiropractic)
• Family Support Center
• Fammull, Inc. (BrightStar Mountainside)
• Luis B. Fandino, MD
• James C Fang
• John C Fang, MD
• Taniela Ma'U Fangupo
• Angela Marie Fanjul, LCSW

• Vascular Surgery Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Vascular Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; 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.