Martha L McCusker, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

31121 Issued in MN

Practice address

701 Park Ave
Minneapolis, MN 55415-1623

Phone

(612) 873-2723

Fax

(612) 904-4243

NPI assigned

May 28, 2006

Sex

Female

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

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Hennepin Healthcare System, Inc

  • Rehabilitation Hospital Unit
  • Minneapolis, MN
  • NPI 1033138136
  Medicare reassignment NPD
• Hennepin Healthcare System Inc

  • Specialty Pharmacy
  • Minneapolis, MN
  • NPI 1619567625
  NPD
• Hennepin Healthcare System, Inc

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1407897309
  NPD

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349222400000",
    "number": "1184671836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-2723",
            "fax_number": "612-904-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCUSKER",
        "first_name": "MARTHA",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-28",
        "last_updated": "2012-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MN",
            "license": "31121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "456093100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Betsy Jean McCullough, PSY.D., L.P.C.
• Brian Patrick McCullough, LPCC
• John Jeffrey McCullough, MD
• Kristen McCullough, CNM
• Sarah Lindsey McCullough, CNM, FNP-C
• Debra Jean McDermott, RN, CNP
• Mark T McDermott, OD
• Olive McDermott
• Virginia Anne McDermott, PH.D.
• Ashley McDew

• Geriatric Medicine (Internal Medicine) Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Geriatric Medicine (Internal Medicine) Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.