Samantha Madison Gustafson, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA61488948 Issued in WA

Practice address

714 W Pine St BLDG C
Newport, WA 99156-9046

Phone

(509) 447-3139

Fax

(509) 897-8597

NPI assigned

Aug 24, 2022

Last updated

Jun 10, 2024By the provider in NPPES

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Washington School of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pend Oreille County Public Hospital District No 1Group PAC ID 3274431184, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Newport Community Hospital Hospital, Newport, WA, CCN 501310
• Bonner General Hospital Hospital, Sandpoint, ID, CCN 131328
• Kootenai Health Hospital, Coeur D'Alene, ID, CCN 130049

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shilfiker2537997@wm.providencedirect.org

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.

• Pend Oreille County Public Hospital District No 1

  dba Newport Community Hospital

  • Emergency Medicine Physician
  • Newport, WA
  • NPI 1427264795
  Medicare reassignment Care Compare group
• Pend Oreille County Public Hospital District No 1

  dba Newport Health Center

  • Clinic/Center
  • Newport, WA
  • NPI 1720294002
  NPD
• Pend Oreille County Public Hospital District No 1

  dba Newport Health Center

  • Rural Health Clinic/Center
  • Newport, WA
  • NPI 1912026360
  NPD (past)

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

• Pend Oreille County Public Hospital District No 1

  dba Newport Community Hospital

  • Critical Access Hospital
  • Newport, WA
  • NPI 1780778423
  Care Compare affiliation
• Bonner General Hospital Inc.

  dba Bonner General Health

  • Critical Access Hospital
  • Sandpoint, ID
  • NPI 1154563963
  Care Compare affiliation
• Kootenai Health, Inc.

  • General Acute Care Hospital
  • Coeur d'Alene, ID
  • NPI 1992798409
  Care Compare affiliation

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1376262246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 W PINE ST",
            "city": "NEWPORT",
            "state": "WA",
            "postal_code": "991569046",
            "telephone_number": "509-447-3139",
            "fax_number": "509-897-8597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 W PINE ST BLDG C",
            "city": "NEWPORT",
            "state": "WA",
            "postal_code": "991569046",
            "telephone_number": "509-447-3139",
            "fax_number": "509-897-8597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "SAMANTHA",
        "middle_name": "MADISON",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-24",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA61488948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaarsten Marie Furman, LICSW
• Curtis Gill
• Karla J Gowan, D.P.T.
• Katie Green
• Groom Enterprises (Newport Ambulance)
• Larry Hagat
• Andrew P Hansen, CRNA
• Lise Jane Harrington, D.C., L.A.C.
• Rebecca Ann Harris
• Kyla Hartley

• Medical Physician Assistant in Newport, WA
• Providers in Newport, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; 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.