NPIMap

Individual provider Active NPI

Andrew Kirby Gustavson, PA-C

  • Physician Assistant
  • Waxhaw, NC
National Provider Identifier
1306571302
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-12435 Issued in NC
Practice address
3614 Providence Rd S Ste 200
Waxhaw, NC 28173-6310
Phone
(704) 384-8640
Fax
(704) 384-8650
NPI assigned
Jul 22, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-12435 NC Primary

Addresses

Primary practice location

3614 Providence Rd S Ste 200
Waxhaw, NC 28173-6310

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

2682 Court Dr Ste B
Gastonia, NC 28054-1442
Phone (704) 824-0500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221118001648 NC Practitioner - Physician Assistant 5395121156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urology Specialists of the Carolinas PLLCGroup PAC ID 0648178020, 78 clinicians

Practice addresses (Care Compare)

1450 Matthews Township Pkwy
Suite 350
Matthews, NC 28105-2388
Phone (704) 841-8877

Hospital & facility affiliations

  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
  • Novant Health Ballantyne Medical Center Hospital, Charlotte, NC, CCN 340195
  • Novant Health Mint Hill Medical Center Hospital, Charlotte, NC, CCN 340190

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Interoperability endpoints

  • Direct secure messaging: andrew.gustavson.1@15570.direct.athenahealth.com
  • Direct secure messaging: dgustavson@urologyspecialistsnc.emadirect.md
  • Direct secure messaging: agustavson360612@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 1

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 7

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": "1658448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1306571302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3614 PROVIDENCE RD S STE 200",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736310",
            "telephone_number": "704-384-8640",
            "fax_number": "704-384-8650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2682 Court Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280541442",
            "country_code": "US",
            "telephone_number": "704-824-0500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAVSON",
        "first_name": "ANDREW",
        "middle_name": "KIRBY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-22",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waxhaw, NC

Sources for this page

Verify at the official NPI Registry.