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

Organization subpart

No

Name

Foluso Fakorede, MDNPI 1679730329

Title

President

Phone

(888) 757-0838

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Foluso A Fakorede, MD

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

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

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

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in MS

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 25, 2018.

{
    "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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• All providers in Cleveland, MS
• 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.