FRED KUSUMOTO (NPI# 1265429427) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265429427 |
| Entity Type | Individual |
| Full Name | FRED KUSUMOTO |
| Credential | MD |
| Practice Address |
4500 San Pablo Rd S Jacksonville FL 32224-1865 |
| Practice Telephone | 9049532000 |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2020-08-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
ME91015 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
4500 SAN PABLO RD S |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32224-1865 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891799136 | Richard Clarke Agnew | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-06-01 |
| 1427657964 | Brianna Iannarelli | Nurse Anesthetist, Certified Registered | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-24 |
| 1538768981 | Heather Anne Dahlen | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-17 |
| 1578161717 | Szilvia Fortner | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-10 |
| 1265049464 | Carolyn Gonzalez | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-09-30 |
| 1467065748 | Ifeloluwa A Olutola | Family Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-26 |
| 1366055568 | Krina Dipak Vyas | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-26 |
| 1356954911 | Haleigh Diane Shelton | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-24 |
| 1215548805 | Victoria Zeilinger Reams | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-16 |
| 1558971382 | Rachel Marie Hannon | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356974372 | Noelle Parker | Specialist/Technologist | 1 Unf Drivve, Jacksonville, FL 32224 | 2020-02-18 |
| 1124685102 | Charcy Rene Stiller | Specialist/Technologist | 1 Unf Dr., Jacksonville, FL 32224 | 2019-05-24 |
| 1265097513 | Mayo Clinic Jacksonville | Ambulance | 13970 Zumbro Dr, Jacksonville, FL 32224 | 2019-05-02 |
| 1639681471 | Brigantti Anesthesia & Spine Care | Clinic/Center | 1361 13th Ave South Suite #210, Jacksonville, FL 32224 | 2017-11-02 |
| 1093240061 | Beric Emilio Berlioz | Anesthesiology | 4500 San Pablo Rd S # J, Jacksonville, FL 32224 | 2017-04-26 |
| 1609240746 | Matthew James Dailey | Nurse Anesthetist, Certified Registered | 2500 San Pablo Rd S, Jacksonville, FL 32224 | 2015-11-29 |
| 1003299603 | Upscale Personal Care Home | Assisted Living Facility | 4375 Autumn River Road, Jacksonville, FL 32224 | 2015-07-01 |
| 1629459375 | Bellanid Fonseca | Social Worker | 3694 Summerlin Ln E, Jacksonville, FL 32224 | 2015-06-17 |
| 1164840500 | Nicholas Scotto | Physical Therapist | 11555 Central Pkwy Ste 1104, Jacksonville, FL 32224 | 2014-04-02 |
| 1497093454 | Quicker Care Urgent Care | Point of Service | 13770 Beach Blvd., Unit # 4, Jacksonville, FL 32224 | 2013-01-27 |
| Find all providers in zip 32224 | ||||
| Taxonomy Code | 207RC0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Clinical Cardiac Electrophysiology |
| A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629511035 | Ibrahim Heart Clinic Pllc | Internal Medicine | 13842 Harbor Creek Pl, Jacksonville, FL 32224-6895 | 2016-12-02 |
| 1992707327 | Robert A Luke | Internal Medicine | 4205 Belfort Rd, Suite 2069, Jacksonville, FL 32216-1471 | 2005-08-15 |
| 1104829399 | Jay R Patterson | Internal Medicine | 1801 Barrs St, Ste 500, Jacksonville, FL 32204-4746 | 2005-05-23 |
| 1851551121 | University of Florida Jacksonville Physicians Inc | Internal Medicine | 655 W 8th St, Ufjp Cardiology, Jacksonville, FL 32209-6511 | 2008-06-11 |
| 1083898449 | Aaditya Mahendra Vora | Internal Medicine | 820 Prudential Dr, Suite 112, Jacksonville, FL 32207-8210 | 2007-12-20 |
| 1174596324 | Lakshminarayana Venkatachalam | Internal Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2006-02-08 |
| 1710974977 | Thomas Flipse | Internal Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-10-03 |
| 1932101334 | Satish R Goel | Internal Medicine | 7011 A C Skinner Pkwy, Suite 160, Jacksonville, FL 32256-6954 | 2005-08-15 |
| 1437152600 | James Timothy Walsh | Internal Medicine | 1824 King Street, Suite 300, Jacksonville, FL 32204-4736 | 2005-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356957336 | Charlotte Arrhythmia Center Pllc | Internal Medicine | 3400 Tamiami Trl Bldg 2, Port Charlotte, FL 33952-8102 | 2020-09-16 |
| 1396365623 | Tallahassee Memorial Healthcare Inc | Internal Medicine | 2100 Centerville Rd, Tallahassee, FL 32308-4379 | 2020-04-16 |
| 1780150524 | Winter Haven Hospital Inc | Internal Medicine | 200 Avenue F Ne Fl 2, Winter Haven, FL 33881-4131 | 2018-10-19 |
| 1154897130 | Sujata S. Balulad, Md., Pa | Internal Medicine | 1095 Highway A1a Apt 2201, Satellite Beach, FL 32937 | 2018-10-17 |
| 1710385240 | Heart Rhythm Center of South Florida Pa | Internal Medicine | 7000 Sw 97th Ave., Suite 102, Miami, FL 33173-1474 | 2014-12-16 |
| 1306262712 | Ian Parker | Internal Medicine | 6720 Crews Wood Ln, Lakeland, FL 33813-3955 | 2014-03-10 |
| 1578987855 | Integrated Care,llc | Internal Medicine | 603 North Flamingo Road, Suite 255, Pembroke Pines, FL 33028-1013 | 2014-02-07 |
| 1861768061 | Zubin Agarwal | Internal Medicine | 1600 Sw Archer Rd # 5, Gainesville, FL 32610-1473 | 2012-04-02 |
| 1427340355 | Asim S Ahmed | Internal Medicine | 7720 Us Highway 98 W Ste 110, Miramar Beach, FL 32550 | 2011-05-11 |
| 1407184377 | Sunil Kumar | Internal Medicine | 311 West Oak Street, Department of Cardiology, Kissimmee, FL 34741-2265 | 2009-12-03 |
| Find all providers with the same taxonomy | ||||
| City | JACKSONVILLE |
| Zip Code | 32224 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.