NPIMap

Individual provider Active NPI

Holly Gustafson, ANP

  • Family Nurse Practitioner
  • Fort Collins, CO
National Provider Identifier
1396173886
Registry record updated Apr 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0990927-NP Issued in CO
Practice address
1124 E Elizabeth St Ste C
Fort Collins, CO 80524-4051
Phone
(970) 484-0798
Fax
(970) 482-0679
NPI assigned
Oct 22, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0990927-NP CO Primary

Addresses

Primary practice location

1124 E Elizabeth St Ste C
Fort Collins, CO 80524-4051

Mailing address

1124 E Elizabeth St Ste C
Fort Collins, CO 80524-4051
Phone (970) 484-0798

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20150121001540 CO Practitioner - Nurse Practitioner 4082938022 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
May accept Medicare assignment
Group practices
The Family Clinic of Fort CollinsGroup PAC ID 5890684179, 8 clinicians

Practice addresses (Care Compare)

1212 E Elizabeth St
Fort Collins, CO 80524-4007
Phone (970) 482-2791

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0990927-NPCOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Family Clinic of Fort Collins CurrentSince Sep 1, 2020 Accepting new patients
Julie Devita-Bailey, D.O., P.C. PastSince Sep 1, 2020 Accepting new patients

Locations

1212 E Elizabeth St
Fort Collins, CO 80524
Phone (970) 482-2791

Interoperability endpoints

  • Direct secure messaging: holly.gustafson.p1@direct.rockymtnfamilyphys.nextgenshare.com

Organizations & group practices 2

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491955200000",
    "number": "1396173886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 E ELIZABETH ST STE C",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244051",
            "telephone_number": "970-484-0798",
            "fax_number": "970-482-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 E ELIZABETH ST STE C",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244051",
            "telephone_number": "970-484-0798",
            "fax_number": "970-482-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "HOLLY",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-22",
        "last_updated": "2017-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "0990927-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.