Blake Gustafson, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

C1-0009550 Issued in DE

Practice address

4755 Ogletown Stanton Rd
Department of Emergency Medicine
Newark, DE 19718-2200

Phone

(302) 733-1840

NPI assigned

Jun 1, 2007

Last updated

May 10, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

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

Specialty

Emergency Medicine

Education

University of Minnesota Medical School, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford Medical CenterGroup PAC ID 8325950215, 847 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sanford Usd Medical Center Hospital, Sioux Falls, SD, CCN 430027

Merit-based Incentive Payment System (MIPS)

Final score

84.78 of 100Reported as group

Quality

78.77

Promoting interoperability

100

Improvement activities

40

Cost

70.49

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Sanford Medical Center

  dba Edith Sanford Breast Specialty Clinic

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1093090342
  Medicare reassignment Care Compare group NPD

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

• Sanford Medical Center

  dba Sanford USD Medical Center

  • Air Ambulance
  • Sioux Falls, SD
  • NPI 1023299708

  Hospital

  Care Compare affiliation
• Sanford Medical Center

  dba Edith Sanford Breast Specialty Clinic

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1093090342

  Hospital

  Care Compare affiliation
• Sanford Medical Center

  dba Sanford USD Medical Center

  • General Acute Care Hospital
  • Sioux Falls, SD
  • NPI 1821017880
  Care Compare affiliation

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368144000000",
    "number": "1467654442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7529",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197147529",
            "telephone_number": "302-294-1468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-1840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2013-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "DE",
            "license": "C1-0009550",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C1-0009550",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "C1-0009550",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kanika Gupta, M.D.
• Maya Gupta, M.D.
• Monika Gupta, M.D.
• Saurabh Gupta, MD
• Shivali Gupta
• Geoffrey Peter Gustavsen, M.D.
• Amanda Guth, DO, MPH
• Jeffrey W Gutting, PA
• Carole A Guy, M.D.
• Stacie Guyton, NP

• Emergency Medicine Physician in Newark, DE
• Providers in Newark, DE by specialty
• Emergency Medicine Physician in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; 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.