Jordan Richard Gustafson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2349 Issued in NE

Practice address

1301 Grundman Blvd
Nebraska City, NE 68410-3319

Phone

(402) 873-3321

NPI assigned

Mar 14, 2019

Last updated

Mar 14, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CHI Health Clinic Specialty LLCGroup PAC ID 4789098443, 317 clinicians

St Marys Community HospitalGroup PAC ID 7113831926, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Angels Care Home Health Home health agency, Omaha, NE, CCN 287132
• CHI Health St Mary's Hospital, Nebraska City, NE, CCN 281342

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jordangustafson@cneb.allscriptsdirect.net

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

• CHI Health Clinic Specialty, LLC

  • Hospitalist Physician
  • Lincoln, NE
  • NPI 1285138065
  Medicare reassignment Care Compare group
• St. Mary's Community Hospital

  dba CHI Health St. Mary's

  • Critical Access Hospital
  • Nebraska City, NE
  • NPI 1528016995
  Medicare reassignment Care Compare group
• St. Mary's Community Hospital

  dba Nebraska City Medical Clinic

  • Rural Health Clinic/Center
  • Nebraska City, NE
  • NPI 1851737316
  NPD

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

• Midwest Home Health Inc

  dba Angels Care Home Health

  • Home Health Agency
  • Omaha, NE
  • NPI 1467582148
  Care Compare affiliation
• St. Mary's Community Hospital

  dba CHI Health St. Mary's

  • Critical Access Hospital
  • Nebraska City, NE
  • NPI 1528016995
  Care Compare affiliation

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

{
    "created_epoch": "1552521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552521600000",
    "number": "1033678644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 GRUNDMAN BLVD",
            "city": "NEBRASKA CITY",
            "state": "NE",
            "postal_code": "684103319",
            "telephone_number": "402-873-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 GRUNDMAN BLVD",
            "city": "NEBRASKA CITY",
            "state": "NE",
            "postal_code": "684103319",
            "telephone_number": "402-873-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "JORDAN",
        "middle_name": "RICHARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-14",
        "last_updated": "2019-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pam Gress
• Rebecca Groff, BCBA
• Benjamin Ralph Grote, RPH
• Kranthi Guntagani, M.S
• Haylee M Gustafson, MPAS, PA-C
• Mitchell Hagedorn, PT, DPT
• Briley Jean Hakel, PA-C
• Marissa Hanika
• Jill Hardy, RN
• Heartland Roots & Refuge, LLC

• Physician Assistant in Nebraska City, NE
• Providers in Nebraska City, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; 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.