John Richard Casuccio, M.D.
Individual provider Active NPI Pediatric Surgery Physician · Martinsburg, WV
NPI 1477523967 · NPPES record last updated Jan 8, 2015
Key facts
- NPI
- 1477523967
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Surgery Physician 2086S0120X
- License
- 12657 (WV)
- Practice address
- 2000 Foundation Way Ste 3650
Martinsburg, WV 25401-9197 - Phone
- (304) 350-3274
- Fax
- (304) 350-3404
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080226000006 | WV | Practitioner - Plastic and Reconstructive Surgery |
8527142892 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Healthcare Physicians Inc | Current |
Accepting new patients | |
| University Healthcare Physicians, Inc. | Current |
Accepting new patients | |
| University Healthcare Physicians, Inc. | Past |
Accepting new patients |
Locations
2000 Foundation Way
Ste 3100
Martinsburg, WV 25401
Phone (304) 260-1436
2000 Foundation Way
Ste 3650
Martinsburg, WV 25401
Phone (304) 350-3274
2500 Foundation Way
Martinsburg, WV 25401
Phone (304) 264-9202
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 0101042197 | VA | |
| Pediatric Surgery Physician | 2086S0120X | 12657 | WV | Yes |
Addresses
Primary practice location
2000 Foundation Way Ste 3650
Martinsburg, WV 25401-9197
Mailing address
2500 Foundation Way
Martinsburg, WV 25401-9000
Phone (304) 264-9202
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810011293 | Medicaid | WV |
Other providers in Martinsburg, WV
- Kathleen Casaly
- Carol Cashwell
- Ismary Castillo-Peguero
- Rebecca Casto
- Victoria Castro-Orogo
- Richard H Catlett
- Brittany Caton
- Diana Catron
- Sarah Catrow
- Gina Lee Caudill
All providers in Martinsburg, WV · Pediatric Surgery Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.