Individual provider Active NPI

Lucas Rabeno Fasolo, M.D.

  • Internal Medicine Physician
  • Miami, FL
National Provider Identifier
1154704906
Registry record updated Oct 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME152888 Issued in FL
Practice address
20801 NW 2ND Ave
Miami, FL 33169-2103
Phone
(305) 653-1770
Fax
(786) 725-3453
NPI assigned
Jun 29, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 264115 MA
Internal Medicine Physician 207R00000X 277164 MA
Internal Medicine Physician 207R00000X ME152888 FL Primary

Addresses

Primary practice location

20801 NW 2ND Ave
Miami, FL 33169-2103

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 653-1770

Other practice location 1

495 Western Ave
Brighton, MA 02135-1007
Phone (617) 783-0500

Other practice location 2

115 Lincoln St
Framingham, MA 01702-6358
Phone (508) 383-1000

Other identifiers 1

IdentifierTypeStateIssuer
237221597MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210923000668 FL Practitioner - Internal Medicine 7113269804 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
264115MAMDInternal Medicine Physician

Organizations & group practices 1

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": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1154704906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-653-1770",
            "fax_number": "786-725-3453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20801 NW 2ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331692103",
            "telephone_number": "305-653-1770",
            "fax_number": "786-725-3453"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "495 Western Ave",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "MA",
            "postal_code": "021351007",
            "country_code": "US",
            "telephone_number": "617-783-0500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Lincoln St",
            "address_purpose": "LOCATION",
            "city": "Framingham",
            "state": "MA",
            "postal_code": "017026358",
            "country_code": "US",
            "telephone_number": "508-383-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RABENO FASOLO",
        "first_name": "LUCAS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-29",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "264115",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "277164",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME152888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "237221597",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.