Individual provider Active NPI

Carmina M Fusco, DPM

  • Foot Surgery Podiatrist
  • San Antonio, TX
National Provider Identifier
1104822683
Registry record updated Apr 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
1812 Issued in TX
Practice address
1715 McCullough Ave
2ND Floor
San Antonio, TX 78212-4046
Phone
(210) 732-3668
Fax
(201) 732-3338
NPI assigned
Jun 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X 1812 TX Primary

Addresses

Primary practice location

1715 McCullough Ave
2ND Floor
San Antonio, TX 78212-4046

Mailing address

1715 McCullough Ave
2ND Floor
San Antonio, TX 78212-4046
Phone (210) 732-3668

Other identifiers 4

IdentifierTypeStateIssuer
TXB154993OtherWELLMED NETWORKS INC
8J1317OtherTXBCBS
0035PTOtherTXBCBS
TXB126362OtherTXWELLMED

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
246NMMDPhysical Therapist

Interoperability endpoints

  • Direct secure messaging: carmina.fusco@wellmed.eclinicaldirectplus.com

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492646400000",
    "number": "1104822683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 MCCULLOUGH AVE",
            "address_2": "2ND FLOOR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782124046",
            "telephone_number": "210-732-3668",
            "fax_number": "201-732-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 MCCULLOUGH AVE",
            "address_2": "2ND FLOOR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782124046",
            "telephone_number": "210-732-3668",
            "fax_number": "201-732-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSCO",
        "first_name": "CARMINA",
        "middle_name": "M",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-21",
        "last_updated": "2017-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "TX",
            "license": "1812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMED NETWORKS INC",
            "identifier": "TXB154993",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8J1317",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0035PT",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMED",
            "identifier": "TXB126362",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.