Individual provider Active NPI

Mark Andrew Fusunyan, MD

  • Psychiatry Physician
  • San Jose, CA
National Provider Identifier
1568984953
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
172926 Issued in CA
Practice address
871 Enborg CT
San Jose, CA 95128-2645
Phone
(408) 855-5100
NPI assigned
Jul 7, 2017
Last updated
Dec 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 271557 MA
Psychiatry Physician 2084P0800X 172926 CA Primary

Addresses

Primary practice location

871 Enborg CT
San Jose, CA 95128-2645

Mailing address

871 Enborg CT
San Jose, CA 95128-2645
Phone (408) 855-5100

Other practice location 1

55 Fruit St
Massachusetts General Hospital
Boston, MA 02114-2621
Phone (617) 726-9550

Other practice location 2

401 Quarry Rd
Palo Alto, CA 94304-1419
Phone (781) 835-5720

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20210916003128 CA Practitioner - PsychiatryPractitioner - Neuropsychiatry 1759654932 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Neuropsychiatry
Education
University of Massachusetts Medical School, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Santa ClaraGroup PAC ID 1254244973, shared by 46 NPIs, 1,000 clinicians

Practice addresses (Care Compare)

751 S Bascom Ave
Santa Clara Vly Med
San Jose, CA 95128-2604
Phone (408) 885-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
61 of 100Reported as group
Quality
59.41
Promoting interoperability
0
Improvement activities
40
Cost
71.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
172926CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Sep 13, 2021 Accepting new patients
County of Santa Clara CurrentSince Sep 13, 2021 Accepting new patients
County of Santa Clara CurrentSince Sep 13, 2021 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Sep 13, 2021 Accepting new patients

Locations

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

871 Enborg Ct
San Jose, CA 95128
Phone (408) 885-6100

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

Interoperability endpoints

  • Direct secure messaging: mfusunyan178810@santaclaravalley.direct-ci.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1568984953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "871 ENBORG CT",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282645",
            "telephone_number": "408-855-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "871 ENBORG CT",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282645",
            "telephone_number": "408-855-5100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Fruit St",
            "address_2": "Massachusetts General Hospital",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021142621",
            "country_code": "US",
            "telephone_number": "617-726-9550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 Quarry Rd",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "943041419",
            "country_code": "US",
            "telephone_number": "781-835-5720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUSUNYAN",
        "first_name": "MARK",
        "middle_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-07",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "271557",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "172926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.