Caitlin J. Gustafson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M9146 Issued in ID

Practice address

211 Forest St
McCall, ID 83638

Phone

(208) 634-2225

Fax

(208) 634-5547

NPI assigned

Jul 1, 2006

Sex

Female

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 4

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

Family PracticeAlso: Emergency Medicine

Education

University of Colorado School of Medicine, Denver, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Lukes Clinic - McCall LLC 44 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke'S McCall Hospital, McCall, ID, CCN 131312
• St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
• Cascade Medical Center Hospital, Cascade, ID, CCN 130779

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St Lukes Clinic - McCall LLC

  • Family Medicine Physician
  • McCall, ID
  • NPI 1881982510

  Family Medicine, ID

  Medicare reassignment Care Compare group NPD
• St Lukes McCall, LTD

  • Family Medicine Physician
  • McCall, ID
  • NPI 1336457738

  Family Medicine

  NPD (past)
• Inland Empire Hospital Services Association

  • Family Medicine Physician
  • Spokane, WA
  • NPI 1326002163

  Family Medicine

  NPD (past)

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

• Cascade Medical Center Hospital District

  • Rural Acute Care Hospital
  • Cascade, ID
  • NPI 1689720435

  Hospital

  Care Compare affiliation
• St Lukes McCall LTD

  • Critical Access Hospital
  • McCall, ID
  • NPI 1235447970

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343865600000",
    "number": "1295764405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1047",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836381047",
            "telephone_number": "208-634-2225",
            "fax_number": "208-634-5547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 FOREST ST",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "83638",
            "telephone_number": "208-634-2225",
            "fax_number": "208-634-5547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "CAITLIN",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2012-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M9146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC CMMC",
            "identifier": "B6157",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS PLMC",
            "identifier": "000010157054",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC PLMC",
            "identifier": "76664",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806631600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Leigh Forkan
• Heidi Lee Galyardt, PHARMD
• Mallorie Leigh Getto, LCSW
• Jane Goodson
• Krystle Beth Grothjan, NP
• Kephri Nanci Gwinn
• David A. Hall, MD
• Philip M Hamby, MD
• Scott S. Harris, MD
• Megan Hatt, PHARMD

• All providers in McCall, ID
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; 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.