Paul Russell Gustavson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA17059 Issued in CA

Practice address

2826 Harris St
Eureka, CA 95503-4809

Phone

(707) 443-8066

Fax

(707) 268-3250

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Joseph Hospital Hospital, Eureka, CA, CCN 050006

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pgustavson1648046@oc.providencedirect.org

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.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group NPD (past)
• Providence Medical Foundation

  • Obstetrics & Gynecology Physician
  • Napa, CA
  • NPI 1205131950
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• East Bay Orthopaedic Specialists Medical Corporation

  • Orthopaedic Surgery Physician
  • Oakland, CA
  • NPI 1699820969
  NPD (past)
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Eureka, CA
  • NPI 1609858950
  NPD (past)

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

• St. Joseph Health Northern California, LLC

  • Home Infusion Therapy Pharmacy
  • Eureka, CA
  • NPI 1568422319

  Hospital

  Care Compare affiliation
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Eureka, CA
  • NPI 1609858950
  Care Compare affiliation
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Eureka, CA
  • NPI 1891900635
  Care Compare affiliation

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1295754752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2826 HARRIS ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955034809",
            "telephone_number": "707-443-8066",
            "fax_number": "707-268-3250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2826 HARRIS ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955034809",
            "telephone_number": "707-443-8066",
            "fax_number": "707-268-3250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAVSON",
        "first_name": "PAUL",
        "middle_name": "RUSSELL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0PA170590",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pgustavson1648046@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2826 Harris St",
            "city": "Eureka",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955034809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elaina Gueyger
• Cassie E Guido
• Rebecca Michele Guillen
• Todd James Gupton Jr.
• Lisa Lee Gust
• Belen Gutierrez-Flores
• Sophia Marie Helena Gutierrez, PA-C
• Ryan Chick-Wah Guyton
• Mayra Liliana Guzman Sanchez, RN
• Hannah Megan Haas

• Physician Assistant in Eureka, CA
• Providers in Eureka, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.