Thomas Carl Gustafson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OP00001187 Issued in WA

Practice address

1717 NW Market St
Seattle, WA 98107-5225

Phone

(206) 782-0500

Fax

(206) 782-0502

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1285669093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 NW MARKET ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981075225",
            "telephone_number": "206-782-0500",
            "fax_number": "206-782-0502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 NW MARKET ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981075225",
            "telephone_number": "206-782-0500",
            "fax_number": "206-782-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "THOMAS",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP00001187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1046325",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lane Gustafson
• Mara Catherine Gustafson, PHD
• Renelle Gustafson, MSW, LICSW
• Sarah Lynn Gustafson, P.T.
• Tara Gustafson
• Tiffany Ann Gustafson, RN
• Emily Baccile Gustin, LMHCA
• Joan F Gustin, LMP
• Michael Joseph Gustin
• Jenny Lynn Gutama Kulas, LICSW

• Family Medicine Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.