Individual provider Active NPI

Erianne Marie Gustaf, DPT

  • Physical Therapist
  • Bellevue, WA
National Provider Identifier
1063768976
Registry record updated Jul 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60288336 Issued in WA
Practice address
4455 148TH Ave NE
Bellevue, WA 98007-3120
Phone
(425) 861-6255
NPI assigned
Jul 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT60288336 WA Primary

Addresses

Primary practice location

4455 148TH Ave NE
Bellevue, WA 98007-3120

Mailing address

616 4TH Ave W
#206
Seattle, WA 98119-4482
Phone (612) 251-3098

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220207000749 WA Practitioner - Physical Therapist in Private Practice 3072906528 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

275 Bronson Way NE
Renton, WA 98056-4030
Phone (425) 235-2800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT60288336WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jan 10, 2022 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jan 10, 2022 Accepting new patients

Locations

275 Bronson Way NE
Renton, WA 98056
Phone (425) 235-2800

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1343520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343520000000",
    "number": "1063768976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 4TH AVE W",
            "address_2": "#206",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981194482",
            "telephone_number": "612-251-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 148TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073120",
            "telephone_number": "425-861-6255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAF",
        "first_name": "ERIANNE",
        "middle_name": "MARIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-29",
        "last_updated": "2012-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60288336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.