Individual provider Active NPI

Robert P Fucetola, PHD

  • Clinical Neuropsychologist
  • Saint Louis, MO
National Provider Identifier
1023035656
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
01900 Issued in MO
Practice address
4444 Forest Park Ave
Div Neuropsychology, 2ND FL
Saint Louis, MO 63108-2212
Phone
(314) 362-1408
Fax
(314) 454-7759
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 01900 MO Primary

Addresses

Primary practice location

4444 Forest Park Ave
Div Neuropsychology, 2ND FL
Saint Louis, MO 63108-2212

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-1408

Other identifiers 1

IdentifierTypeStateIssuer
490089004MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100816000370 MO Practitioner - Clinical Psychologist 4082748850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Washington University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

4444 Forest Park Ave
Suite 2600
Saint Louis, MO 63108-2212
Phone (314) 454-7756

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Dec 7, 1998 Accepting new patients
Washington University CurrentSince Dec 7, 1998 Accepting new patients
Washington University Past Accepting new patients

Locations

4444 Forest Park Ave
Fl 2
Saint Louis, MO 63108

1 Barnes Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-9170

660 S Euclid Ave
#8111
Saint Louis, MO 63110
Phone (314) 362-3281

4455 Duncan Ave
Saint Louis, MO 63110
Phone (314) 658-3800

4444 Forest Park Ave
Ste 2600
Saint Louis, MO 63108

660 S Euclid Ave
#C
Saint Louis, MO 63110

Networks

  • devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d
  • IA HMO
  • IA HMO C-SNP

Interoperability endpoints

  • Direct secure messaging: rfucetola160350@direct.carenet.org

Organizations & group practices 3

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1023035656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-1408",
            "fax_number": "314-454-7759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 FOREST PARK AVE",
            "address_2": "DIV NEUROPSYCHOLOGY, 2ND FL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082212",
            "telephone_number": "314-362-1408",
            "fax_number": "314-454-7759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUCETOLA",
        "first_name": "ROBERT",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MO",
            "license": "01900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "490089004",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4444 Forest Park Ave",
            "address_2": "Div Neuropsychology, 2nd Fl",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.