Individual provider Active NPI

David Kevin Gustavison, D.O.

  • Family Medicine Physician
  • Saginaw, MI
National Provider Identifier
1467427682
Registry record updated Sep 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101010467 Issued in MI
Practice address
900 Cooper Ave
Suite 4400
Saginaw, MI 48602-5182
Phone
(989) 583-4401
Fax
(989) 583-4409
NPI assigned
Feb 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101010467 MI Primary
Occupational Medicine Physician 2083X0100X 5101010467 MI

Addresses

Primary practice location

900 Cooper Ave
Suite 4400
Saginaw, MI 48602-5182

Mailing address

1447 N Harrison St
Saginaw, MI 48602-4727
Phone (989) 583-4401

Other identifiers 1

IdentifierTypeStateIssuer
3508260MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20031209000331 MI Practitioner - Family PracticePractitioner - Osteopathic Manipulative MedicinePractitioner - Emergency Medicine 0648176958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Osteopathic Manipulative Medicine
Education
Michigan State University College of Osteopathic Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Center, Inc.Group PAC ID 2769387778, 488 clinicians

Practice addresses (Care Compare)

1447 N Harrison St
Saginaw, MI 48602-4727
Phone (989) 583-4220

1941 Gates St
Reese, MI 48757-9555
Phone (989) 583-5550

900 Cooper Ave
Saginaw, MI 48602-5182

Hospital & facility affiliations

  • Covenant Medical Center Hospital, Saginaw, MI, CCN 230070

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue16

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Center, Inc. CurrentSince Sep 1, 2014 Accepting new patients

Locations

2919 Wilder Rd
Ste 120
Bay City, MI 48706
Phone (989) 583-4401

900 Cooper Ave
Ste 4400
Saginaw, MI 48602
Phone (989) 583-4401

3875 Bay Rd
Ste 1S
Saginaw, MI 48603
Phone (517) 793-1372

1447 N Harrison St
Saginaw, MI 48602
Phone (989) 583-4220

900 Cooper Ave
Saginaw, MI 48602
Phone (989) 583-6122

700 Cooper Ave
Saginaw, MI 48602
Phone (989) 583-6000

Interoperability endpoints

  • Direct secure messaging: dgustavison1182@direct.covenanthealthcare.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 1

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409702400000",
    "number": "1467427682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1447 N HARRISON ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486024727",
            "telephone_number": "989-583-4401",
            "fax_number": "989-583-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 COOPER AVE",
            "address_2": "SUITE 4400",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486025182",
            "telephone_number": "989-583-4401",
            "fax_number": "989-583-4409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAVISON",
        "first_name": "DAVID",
        "middle_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2014-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101010467",
            "primary": true
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "MI",
            "license": "5101010467",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3508260",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.