Fusion Vascular, LLC

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

Legal business name

FUSION VASCULAR, LLC

Practice address

800 Pearman Ave
Cleveland, MS 38732-3502

Phone

(888) 757-0838

Fax

(888) 796-1835

NPI assigned

Nov 25, 2018

Last updated

Nov 25, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Foluso Fakorede, MDNPI 1679730329

Title

President

Phone

(888) 757-0838

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Foluso A Fakorede, MD

  • Interventional Cardiology Physician
  • Cleveland, MS
  • NPI 1679730329
  Medicare reassignment NPD Authorized official
• Richard Michael Cukelj, DPM

  • Foot & Ankle Surgery Podiatrist
  • Cleveland, MS
  • NPI 1346827482
  NPD (past)

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

{
    "created_epoch": "1543104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543104000000",
    "number": "1497224174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 PALM HARBOR BLVD STE A",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346831930",
            "telephone_number": "727-474-0090",
            "fax_number": "727-474-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PEARMAN AVE",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387323502",
            "telephone_number": "888-757-0838",
            "fax_number": "888-796-1835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUSION VASCULAR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-25",
        "last_updated": "2018-11-25",
        "status": "A",
        "authorized_official_last_name": "FAKOREDE",
        "authorized_official_first_name": "FOLUSO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-757-0838",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Interventional Cardiology Physician in Cleveland, MS
• Providers in Cleveland, MS by specialty
• Interventional Cardiology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.