NPIMap

Individual provider Active NPI

Michael J Gustavel, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Boise, ID
National Provider Identifier
1306842182
Registry record updated Feb 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
M8510 Issued in ID
Practice address
1702 W Fairview Ave
Boise, ID 83702-5121
Phone
(208) 850-1641
NPI assigned
Jun 24, 2005
Last updated
Feb 28, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X M8510 ID Primary

Addresses

Primary practice location

1702 W Fairview Ave
Boise, ID 83702-5121

Mailing address

1188 W University Dr
Boise, ID 83706-3009
Phone (208) 336-8250

Other practice location 1

1188 University Dr
Boise, ID 83706
Phone (208) 336-8250

Other identifiers 1

IdentifierTypeStateIssuer
1306842182MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20040309000323 ID Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 6901794148 Reassigns benefits to 1 organization
Receives reassigned benefits from 2 practitioners
Practice locations: Boise, ID

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
University of Washington School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1702 W Fairview Ave
Boise, ID 83702-5121
Phone (208) 957-7400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
81.29
Promoting interoperability
100
Improvement activities
40
Cost
76.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement28
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M8510IDMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Aug 13, 2018 Accepting new patients
Idaho Sports Medicine Institute PastSince Jan 1, 2004 Accepting new patients
Gustavel Orthopedics PLLC Sports Medicine PastSince Mar 11, 2019 Accepting new patients

Locations

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

3399 E Louise Dr
Ste 200
Meridian, ID 83642

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CHDGBD
  • FHIR API: https://fhir4.healow.com/fhir/r4/CHDGBD/Endpoint/CHDGBD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Treasure Valley HospitalBoise, ID, CCN 130063 Hospital Limited Partnership Interest (2.76%) Oct 15, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551312000000",
    "number": "1306842182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1188 W UNIVERSITY DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063009",
            "telephone_number": "208-336-8250",
            "fax_number": "208-345-9514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 W FAIRVIEW AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025121",
            "telephone_number": "208-850-1641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1188 University Dr",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "83706",
            "country_code": "US",
            "telephone_number": "208-336-8250",
            "fax_number": "208-345-9514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAVEL",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2019-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "ID",
            "license": "M8510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306842182",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.