Individual provider Active NPI

Kristin A Gustafson, DO

  • Physical Medicine & Rehabilitation Physician
  • Philadelphia, PA
National Provider Identifier
1447222765
Registry record updated Dec 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
OS014841 Issued in PA
Practice address
25 S 9TH St FL 1
Philadelphia, PA 19107
Phone
(215) 955-1200
Fax
(215) 923-6808
NPI assigned
Feb 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X MD225827 MA
Physical Medicine & Rehabilitation Physician 208100000X OS014841 PA Primary

Addresses

Primary practice location

25 S 9TH St FL 1
Philadelphia, PA 19107

Mailing address

25 S 9TH St FL 1
Philadelphia, PA 19107-4408
Phone (215) 955-1200

Other practice location 1

3 Crescent Dr Fl 3
Philadelphia, PA 19112-1016
Phone (215) 503-3321

Other identifiers 1

IdentifierTypeStateIssuer
102334750MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20090909000434 PA Practitioner - Physical Medicine and Rehabilitation 6800804907 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
New York College of Osteo Medicine of New York Institute of Technology, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

25 S 9TH St
1St Floor
Philadelphia, PA 19107-4408
Phone (215) 955-1200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD225827MAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Physical Medicine & Rehabilitation CurrentSince Sep 27, 2017 Accepting new patients
Geisinger Clinic CurrentSince Mar 1, 2016 Accepting new patients
Geisinger Clinic CurrentSince Mar 1, 2016 Accepting new patients
Geisinger Clinic Current Accepting new patients
Jefferson University Physicians Past Accepting new patients
Boston Rehabilitation Medicine Associates, Inc. Physical Medicine & Rehabilitation PastSince Sep 5, 2007 Accepting new patients
Magee Rehabilitation Hospital Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

3 Crescent Dr
Fl 3
Philadelphia, PA 19112
Phone (215) 503-3321

25 S 9th St
Fl 1
Philadelphia, PA 19107
Phone (215) 955-1200

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 7

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 4

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": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1447222765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 S 9TH ST FL 1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074408",
            "telephone_number": "215-955-1200",
            "fax_number": "215-923-6808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 S 9TH ST FL 1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "215-955-1200",
            "fax_number": "215-923-6808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Crescent Dr Fl 3",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191121016",
            "country_code": "US",
            "telephone_number": "215-503-3321",
            "fax_number": "215-503-7180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "KRISTIN",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MA",
            "license": "MD225827",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PA",
            "license": "OS014841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102334750",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.