Active NPI
Gary L. Gustafson, D.O.
- Family Medicine Physician
- Belton, MO
National Provider Identifier
1144205345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R8612
- Practice address
- 8015 E. 171St St.
Belton, MO 64012 - Phone
- (816) 331-0961
- Fax
- (816) 322-5236
- NPI assigned
- Dec 9, 2005
- Last updated
- Aug 24, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R8612 | MO | Primary |
Addresses
Primary practice location
8015 E. 171St St.
Belton, MO 64012
Mailing address
8015 E. 171St St.
Belton, MO 64012
Phone (816) 331-0961
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 240300806 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282608000000",
"number": "1144205345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8015 E. 171ST ST.",
"city": "BELTON",
"state": "MO",
"postal_code": "64012",
"telephone_number": "816-331-0961",
"fax_number": "816-322-5236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8015 E. 171ST ST.",
"city": "BELTON",
"state": "MO",
"postal_code": "64012",
"telephone_number": "816-331-0961",
"fax_number": "816-322-5236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "GARY",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-09",
"last_updated": "2010-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R8612",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "240300806",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Belton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.