Dustin John Fanciullo, MD in Salt Lake City, UT

Dustin John Fanciullo, MD is a medicare enrolled "Surgery - Vascular Surgery" physician in Salt Lake City, Utah. He graduated from medical school in 2004 and has 22 years of diverse experience with area of expertise as Vascular Surgery. He is a member of the group practice Clifton Springs Sanitarium Co, Canton-potsdam Hospital and his current practice location is 1160 E 3900 S Ste 3100, Salt Lake City, Utah. You can reach out to his office (for appointments etc.) via phone at (801) 262-2806.

Dustin John Fanciullo is licensed to practice in Utah (license number 14267138-1205) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1013164052.

Contact Information

	Dustin John Fanciullo, MD
	1160 E 3900 S Ste 3100, Salt Lake City, UT 84124-1290
	(801) 262-2806
	Not Available

Map and Direction

Physician's Profile

Full Name	Dustin John Fanciullo
Gender	Male
Speciality	Vascular Surgery
Experience	22 Years
Location	1160 E 3900 S Ste 3100, Salt Lake City, Utah
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Dustin John Fanciullo graduated from medical school in 2004

NPI Data:

NPI Number: 1013164052
Provider Enumeration Date: 08/21/2008
Last Update Date: 03/02/2026

Medicare PECOS Information:

PECOS PAC ID: 0042488041
Enrollment ID: I20110719000037

Medical Identifiers

Medical identifiers for Dustin John Fanciullo such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1013164052	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208600000X	Surgery	14267138-1205 (Utah)	Secondary
2086S0129X	Surgery - Vascular Surgery	14267138-1205 (Utah)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Lifetime Care Chha	Rochester, NY	Home health agency
Clifton Springs Hospital And Clinic	Clifton springs, NY	Hospital
Rochester General Hospital	Rochester, NY	Hospital
Newark-wayne Community Hospital	Newark, NY	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Clifton Springs Sanitarium Co	5092704809	132
Canton-potsdam Hospital	6204827280	199

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dustin John Fanciullo allows following entities to bill medicare on his behalf.

Entity Name	Rochester General Hospital
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1356412712 PECOS PAC ID: 0244149474 Enrollment ID: O20031121000644

Entity Name	The Unity Hospital Of Rochester
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1760421713 PECOS PAC ID: 9436060969 Enrollment ID: O20031230000038

Entity Name	Clifton Springs Sanitarium Co
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1366505463 PECOS PAC ID: 5092704809 Enrollment ID: O20040525000569

Entity Name	Western New York Medical Practice Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1063790608 PECOS PAC ID: 3870767791 Enrollment ID: O20111110000598

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dustin John Fanciullo is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dustin John Fanciullo, MD Po Box 281490, Atlanta, GA 30384-1490 Ph: () -	Dustin John Fanciullo, MD 1160 E 3900 S Ste 3100, Salt Lake City, UT 84124-1290 Ph: (801) 262-2806

Reviews and Comments

Surgery Doctors in Salt Lake City, UT

Dr. Gregory Lawrence Livers, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 129 F St, Salt Lake City, UT 84103 Phone: 801-364-3091
Alexandria Tran, MD Surgery Medicare: May Accept Medicare Assignments Practice Location: 5171 S Cottonwood St Ste 650, Salt Lake City, UT 84107 Phone: 801-507-9600
Dr. Melanie Ann Dance, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 1250 E 3900 S, Salt Lake City, UT 84124 Phone: 801-265-2000
Alexander Schurman, Surgery Medicare: Medicare Enrolled Practice Location: 30 N Mario Capecchi Dr Rm 4s100, Salt Lake City, UT 84112 Phone: 801-581-2121
Kaohinani Joseph Longwolf, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 30 N 1900 E Rm 3c344, Salt Lake City, UT 84132 Phone: 801-213-2598
Marisol Z. Monzon, MD Surgery Medicare: Medicare Enrolled Practice Location: 30 N Mario Capecchi Dr Rm 4s100, Salt Lake City, UT 84112 Phone: 801-581-2121

Dustin John Fanciullo, MD - Medicare Vascular Surgery in Salt Lake City, UT