Individual provider Active NPI

Mark James Fussa, D.O.

  • Infectious Disease Physician
  • Voorhees, NJ
National Provider Identifier
1942407374
Registry record updated Feb 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
25MB08120000 Issued in NJ
Practice address
709 Haddonfield Berlin Rd
Voorhees, NJ 08043-3715
Phone
(856) 566-3190
Fax
(856) 783-2193
NPI assigned
Jun 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 25MB08120000 NJ Primary

Addresses

Primary practice location

709 Haddonfield Berlin Rd
Voorhees, NJ 08043-3715

Mailing address

709 Haddonfield Berlin Rd
Voorhees, NJ 08043-3715

Other identifiers 2

IdentifierTypeStateIssuer
0163520MedicaidNJ
P00728548OtherNJRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20080602000057 NJ Practitioner - Infectious DiseasePractitioner - Internal Medicine 2668542739 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Rowan University School of Osteopathic Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

73 N Maple Ave B
Kennedy Health Alliance
Marlton, NJ 08053-1782
Phone (844) 542-2273

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MB08120000NJMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Medical Group Practice P.C. CurrentSince Mar 13, 2017 Accepting new patients
Kennedy Medical Group Practice PC CurrentSince Mar 13, 2017 Accepting new patients
Kennedy Medical Group Practice, P.C. CurrentSince Jun 15, 2021 Accepting new patients
Kennedy Medical Group Practice P.C. Past Accepting new patients

Locations

457 Haddonfield Rd
Ste 110
Cherry Hill, NJ 08002
Phone (856) 406-4091

73 N Maple Ave
Ste B
Marlton, NJ 08053
Phone (856) 596-0558

151 Fries Mill Rd
Ste 301
Turnersville, NJ 08012
Phone (856) 374-1881

709 Haddonfield Berlin Rd
Voorhees, NJ 08043
Phone (856) 566-3190

333 Laurel Oak Rd
Voorhees, NJ 08043
Phone (856) 344-7360

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488153600000",
    "number": "1942407374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 HADDONFIELD BERLIN RD",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080433715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HADDONFIELD BERLIN RD",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080433715",
            "telephone_number": "856-566-3190",
            "fax_number": "856-783-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSSA",
        "first_name": "MARK",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2017-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NJ",
            "license": "25MB08120000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0163520",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00728548",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Voorhees, NJ

Sources for this page

Verify at the official NPI Registry.