Individual provider Active NPI

Orland S Gustilo, M.D.

  • Psychiatry Physician
  • Lafayette, IN
National Provider Identifier
1255461547
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01028744 Issued in IN
Practice address
3660 Rome Dr
Lafayette, IN 47905-4488
Phone
(765) 446-9394
Fax
(765) 447-8875
NPI assigned
Mar 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 01028744 IN Primary

Addresses

Primary practice location

3660 Rome Dr
Lafayette, IN 47905-4488

Mailing address

3660 Rome Dr
Lafayette, IN 47905-4488
Phone (765) 446-9394

Other identifiers 1

IdentifierTypeStateIssuer
100086080AMedicaidIN

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 Medicine

State licenses

LicenseStateTypeSpecialty
01028744INMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alpine Physicians, LLC Psychiatry PastSince Jan 1, 2018 Accepting new patients
Alpine Clinic, LLC Psychiatry PastSince Jan 1, 1998 Accepting new patients

Organizations & group practices 2

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": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255461547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 ROME DR",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054488",
            "telephone_number": "765-446-9394",
            "fax_number": "765-447-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 ROME DR",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054488",
            "telephone_number": "765-446-9394",
            "fax_number": "765-447-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTILO",
        "first_name": "ORLAND",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01028744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100086080A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.