Hussam A Fustok, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35.134179 Issued in OH

Practice address

272 Hospital Rd
Chillicothe, OH 45601-9031

Phone

(740) 779-8572

NPI assigned

May 21, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

HospitalistAlso: Internal Medicine

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Southeast Missouri Hospital Physicians LLCGroup PAC ID 9133024334, 206 clinicians

Hannibal Regional Healthcare System IncGroup PAC ID 1254236300, 256 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hannibal Regional Hospital Hospital, Hannibal, MO, CCN 260025
• Mercy Hospital Southeast Hospital, Cape Girardeau, MO, CCN 260110
• Blessing Hospital Hospital, Quincy, IL, CCN 140015
• Parkland Health Center Hospital, Farmington, MO, CCN 260163
• Pike County Memorial Hospital Hospital, Louisiana, MO, CCN 261333

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hfustok518697@direct-ehr-ssmhc.com
• FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602

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

• Hannibal Regional Healthcare System Inc

  • Multi-Specialty Clinic/Center
  • Hannibal, MO
  • NPI 1003956095
  Medicare reassignment Care Compare group NPD
• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1285664268

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Southeast Missouri Hospital Physicians, LLC

  • Family Medicine Physician
  • Cape Girardeau, MO
  • NPI 1558311522

  Hospitalist

  Medicare reassignment Care Compare group NPD
• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Farmington, MO
  • NPI 1427114990
  NPD
• Southeast Hospital

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  NPD (past)

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

• Blessing Hospital

  • Nurse Practitioner
  • Quincy, IL
  • NPI 1417204827

  Hospital

  Care Compare affiliation
• Blessing Hospital

  • General Acute Care Hospital
  • Quincy, IL
  • NPI 1760571699
  Care Compare affiliation
• Hannibal Regional Healthcare System, Inc

  • Rural Acute Care Hospital
  • Hannibal, MO
  • NPI 1922042704
  Care Compare affiliation
• Parkland Health Center

  • General Acute Care Hospital
  • Farmington, MO
  • NPI 1003824061
  Care Compare affiliation
• Parkland Health Center

  • Psychiatric Hospital Unit
  • Farmington, MO
  • NPI 1902814866
  Care Compare affiliation
• Pike County Memorial Hospital

  • Critical Access Hospital
  • Louisiana, MO
  • NPI 1205837218
  Care Compare affiliation
• Southeast Hospital

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  Care Compare affiliation

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1740669845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1968 FISHINGER RD",
            "city": "UPPER ARLINGTON",
            "state": "OH",
            "postal_code": "432211372",
            "telephone_number": "281-701-2926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 HOSPITAL RD",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456019031",
            "telephone_number": "740-779-8572"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "57 North St",
            "address_purpose": "LOCATION",
            "city": "Danbury",
            "state": "CT",
            "postal_code": "068105660",
            "country_code": "US",
            "telephone_number": "203-743-0100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3555 Olentangy River Rd Ste 1080",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432143984",
            "country_code": "US",
            "telephone_number": "614-268-8164",
            "fax_number": "614-268-8406",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6000 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Hannibal",
            "state": "MO",
            "postal_code": "634016887",
            "country_code": "US",
            "telephone_number": "573-629-3342",
            "fax_number": "573-629-3432",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 W Liberty St",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "MO",
            "postal_code": "636401921",
            "country_code": "US",
            "telephone_number": "573-705-1272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUSTOK",
        "first_name": "HUSSAM",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-21",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2022045087",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2022045087",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.134179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740669845",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0299838",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1101 W Liberty St",
            "city": "Farmington",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636401921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Leslie K Fultz, LSW
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• Ruby Christine Furniss, RN
• Jamie L Fyffe, C.N.P.
• John A Gabis, MD
• Breanne Marie Gahm, PT, DPT, DS
• Leslie Gallaugher, COTA/L
• Rebekah Brown Gallaugher, CNP

• Internal Medicine Physician in Chillicothe, OH
• Providers in Chillicothe, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.