Individual provider Active NPI

Cheryl Janene Gustafson, MD

  • MOHS-Micrographic Surgery Physician
  • Seattle, WA
National Provider Identifier
1083840565
Registry record updated Jan 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
MD60757392 Issued in WA
Practice address
3216 NE 45TH PL Ste 101
Seattle, WA 98105-4028
Phone
(206) 525-1168
Fax
(206) 525-1169
NPI assigned
Jun 10, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 01075298A IN
MOHS-Micrographic Surgery Physician 207ND0101X MD60757392 WA Primary

Addresses

Primary practice location

3216 NE 45TH PL Ste 101
Seattle, WA 98105-4028

Mailing address

PO Box 24325
Seattle, WA 98124-0325
Phone (062) 327-5462

Other identifiers 1

IdentifierTypeStateIssuer
2084320MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170720002975 WA Practitioner - Dermatology 9234428327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Nevada School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Silver Falls Dermatology LLCGroup PAC ID 5890863492, 100 clinicians

Practice addresses (Care Compare)

3216 NE 45TH PL
Suite 203
Seattle, WA 98105-4028
Phone (206) 525-1168

Hospital & facility affiliations

  • Swedish Edmonds Hospital Hospital, Edmonds, WA, CCN 500026

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision32
Removal of skin lesions457
Removal of skin cancer130
Removal or shaving of skin growth39
Skin biopsy225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Silver Falls Dermatology, LLC Dermatology CurrentSince Apr 1, 2021 Accepting new patients

Locations

1793 13th St SE
Salem, OR 97302
Phone 50336283851283

1515 116th Ave NE
Ste 307
Bellevue, WA 98004
Phone (425) 999-2628

21727 76th Ave W
Ste H
Edmonds, WA 98026
Phone (425) 672-1333

21701 76th Ave W
Ste 100
Edmonds, WA 98026
Phone (206) 525-1168

21701 76th Ave W
Ste 302
Edmonds, WA 98026
Phone (425) 502-5427

1301 4th Ave NW
Ste 302
Issaquah, WA 98027
Phone (206) 305-9963

1106 Douglas St
Ste F
Longview, WA 98632
Phone (360) 636-4500

1338 Commerce Ave
Ste 106
Longview, WA 98632
Phone (971) 915-8587

8435 SE 68th St
Ste 118
Mercer Island, WA 98040
Phone (206) 232-7546

3825 Martin Way E
Ste 104
Olympia, WA 98506
Phone (971) 915-8579

11011 Meridian Ave N
Ste 102
Seattle, WA 98133
Phone (206) 859-5777

3216 NE 45th Pl
Ste 203
Seattle, WA 98105
Phone (206) 525-1168

2415 NE 134th St
Ste 107
Vancouver, WA 98686
Phone (360) 576-3340

Interoperability endpoints

  • Direct secure messaging: cgustafson@frontierdermpartners.emadirect.md

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611878400000",
    "number": "1083840565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24325",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981240325",
            "telephone_number": "062-327-5462",
            "fax_number": "503-362-8435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3216 NE 45TH PL STE 101",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981054028",
            "telephone_number": "206-525-1168",
            "fax_number": "206-525-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "CHERYL",
        "middle_name": "JANENE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-10",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01075298A",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "WA",
            "license": "MD60757392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2084320",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.