Individual provider Active NPI

Jodi E Gustave, MD

  • Pediatric Pulmonology Physician
  • Wilmington, DE
National Provider Identifier
1174554190
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
C10011083 Issued in DE
Practice address
1600 Rockland Rd
Wilmington, DE 19803-3607
Phone
(302) 651-4200
Fax
(302) 651-4945
NPI assigned
Jul 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 095362 OH
Pediatrics Physician 208000000X 062994 GA
Pediatrics Physician 208000000X MD421678 PA
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X MD421678 PA
Pediatric Pulmonology Physician 2080P0214X 25MA08162100 NJ
Hospitalist Physician 208M00000X MD421678 PA
Pediatric Pulmonology Physician 2080P0214X C10011083 DE Primary

Addresses

Primary practice location

1600 Rockland Rd
Wilmington, DE 19803-3607

Mailing address

PO Box 191
Rockland, DE 19732-0191
Phone (302) 651-6212

Other practice location 1

1280 Almonesson Rd
Deptford, NJ 08096-5502
Phone (856) 345-1401

Other identifiers 4

IdentifierTypeStateIssuer
101141866MedicaidPA
0050539MedicaidNJ
1655572OtherPABLUE SHIELD
406294900MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, DE2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090122000740 NJ Practitioner - Pediatric MedicinePractitioner - Pulmonary Disease 6305836057 Reassigns benefits to 1 organization
I20141030001870 DE Practitioner - Pulmonary Disease 6305836057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
New York Medical College, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Nemours FoundationGroup PAC ID 9537072483, 249 clinicians

Practice addresses (Care Compare)

1600 Rockland Rd
Wilmington, DE 19803-3607
Phone (302) 651-4200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
062994GAMDPediatrics Physician
095362OHMDPediatrics Physician
MD421678PAMDPediatric Emergency Medicine (Pediatrics) Physician
C10011083DEMDPediatric Pulmonology Physician
25MA08162100NJMDPediatric Pulmonology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cooper Pediatric Specialists, PC Pediatrics CurrentSince Oct 1, 2014 Accepting new patients
The Nemours Foundation CurrentSince Sep 3, 2014 Accepting new patients
The Nemours Foundation CurrentSince Sep 3, 2014 Accepting new patients
The Nemours Foundation Past Accepting new patients

Locations

101 Wellness Way
Milford, DE 19963
Phone (302) 422-4559

1600 Rockland Rd
Wilmington, DE 19803

3 Cooper Plz
Rm 200
Camden, NJ 08103
Phone (609) 342-2001

6400 Main St
Voorhees, NJ 08043
Phone (609) 751-9339

1280 Almonesson Rd
Woodbury, NJ 08096
Phone (856) 345-1401

1676 Lancaster Ave
Paoli, PA 19301
Phone (610) 644-9233

Interoperability endpoints

  • Direct secure messaging: jgustave50374@direct.nemours.org

Organizations & group practices 4

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 1

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1174554190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-6212",
            "fax_number": "302-651-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 ROCKLAND RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198033607",
            "telephone_number": "302-651-4200",
            "fax_number": "302-651-4945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1280 Almonesson Rd",
            "address_purpose": "LOCATION",
            "city": "Deptford",
            "state": "NJ",
            "postal_code": "080965502",
            "country_code": "US",
            "telephone_number": "856-345-1401",
            "fax_number": "856-805-9370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAVE",
        "first_name": "JODI",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "095362",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "062994",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD421678",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "PA",
            "license": "MD421678",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "NJ",
            "license": "25MA08162100",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "MD421678",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "DE",
            "license": "C10011083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101141866",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0050539",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1655572",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "406294900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

Verify at the official NPI Registry.