Tammy Fusilier, CRNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

R215486 Issued in MD

Practice address

173 Saint Patricks Dr Ste 104
Waldorf, MD 20603-5530

Phone

(240) 729-6250

Fax

(949) 695-4106

NPI assigned

Jul 30, 2019

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

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Ahanna Health and Wellness, LLC

  • Adult Health Nurse Practitioner
  • Waldorf, MD
  • NPI 1891559530
  Medicare reassignment NPD Authorized official
• Southern Maryland Primary Care, LLC

  • Family Medicine Physician
  • Waldorf, MD
  • NPI 1831386630
  Medicare reassignment

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

{
    "created_epoch": "1564444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1366096034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 SAINT PATRICKS DR STE 104",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206035530",
            "telephone_number": "240-729-6250",
            "fax_number": "949-695-4106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 SAINT PATRICKS DR STE 104",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206035530",
            "telephone_number": "240-729-6250",
            "fax_number": "949-695-4106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSILIER",
        "first_name": "TAMMY",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-30",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MD",
            "license": "R215486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fresenius Medical Care Southern Maryland Home, LLC
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• Aryielle Funderburk
• Maribel Furtado, THERAPIST
• Fusion Dental
• Chanell Gaines, LPC
• Mirtha Giannina Galliani Alvarez, D.D.S.
• Milton Abraham Galvan Lam, CRNP
• Stacy Marie Gantz

• Gerontology Nurse Practitioner in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Gerontology Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; 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.