| Dr Robert A Fasano, MD | |
|
N2950 State Road 67, Lake Geneva, WI 53147-2655 | |
| (262) 245-0535 | |
| (262) 245-2248 |
| Full Name | Dr Robert A Fasano |
|---|---|
| Gender | Male |
| Speciality | Hospitalist |
| Experience | 32 Years |
| Location | N2950 State Road 67, Lake Geneva, Wisconsin |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770666471 | NPI | - | NPPES |
| P00917285 | Other | WI | RR MEDICARE |
| 32332100 | Medicaid | WI | |
| FASANROB | Other | WI | MERCYCARE INSURANCE |
| 1770666471 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036-102882 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | 38693-20 (Wisconsin) | Secondary |
| 208M00000X | Hospitalist | 38693-20 (Wisconsin) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Mercy Walworth Hospital & Medical Center | Lake geneva, WI | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Oak Medical Sc | 0042595175 | 99 |
| Mercy Health System Corporation | 7416860440 | 564 |
| Entity Name | Mercy Health System Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1598718603 PECOS PAC ID: 7416860440 Enrollment ID: O20031113000164 |
| Entity Name | Oak Medical Sc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669910345 PECOS PAC ID: 0042595175 Enrollment ID: O20170331001848 |
| Entity Name | Maple Medical Sc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1487152104 PECOS PAC ID: 9032471248 Enrollment ID: O20180328002607 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Robert A Fasano, MD N2950 State Road 67, Lake Geneva, WI 53147-2655 Ph: (262) 245-0535 | Dr Robert A Fasano, MD N2950 State Road 67, Lake Geneva, WI 53147-2655 Ph: (262) 245-0535 |
Susan K. Kinast-porter, MD Hospitalist Medicare: Not Enrolled in Medicare Practice Location: N2950 State Road 67, Lake Geneva, WI 53147 Phone: 262-245-0535 Fax: 262-245-2227 |