Individual provider Active NPI

Charles Anthony Cusimano, DMD

  • General Practice Dentistry
  • Mobile, AL
National Provider Identifier
1669735270
Registry record updated Jun 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5922 Issued in AL
Practice address
301 Saint Joseph St
Mobile, AL 36602-4037
Phone
(251) 433-7717
Fax
(251) 433-9384
NPI assigned
Jun 19, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5922 AL Primary

Addresses

Primary practice location

301 Saint Joseph St
Mobile, AL 36602-4037

Mailing address

301 Saint Joseph St
Mobile, AL 36602-4037
Phone (251) 433-7717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150711000100 AL Order and Referring Only - DentistPractitioner - Dentist 4981916426

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5922ALMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340064000000",
    "number": "1669735270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 SAINT JOSEPH ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366024037",
            "telephone_number": "251-433-7717",
            "fax_number": "251-433-9384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SAINT JOSEPH ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366024037",
            "telephone_number": "251-433-7717",
            "fax_number": "251-433-9384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSIMANO",
        "first_name": "CHARLES",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-19",
        "last_updated": "2012-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

Verify at the official NPI Registry.