NPIMap

Individual provider Active NPI

Casey L Gustavison, ANP

  • Nurse Practitioner
  • Carbondale, IL
National Provider Identifier
1508004706
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209008417 Issued in IL
Practice address
409 W Oak St
Carbondale, IL 62901-1464
Phone
(618) 529-4455
Fax
(618) 351-1287
NPI assigned
Jan 26, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209008417 IL Primary

Addresses

Primary practice location

409 W Oak St
Carbondale, IL 62901-1464

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other identifiers 3

IdentifierTypeStateIssuer
71002863BOtherINCSR
PENDINGMedicaidIN
71002863AOtherINLICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cgustavison15611@sih.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20110325000726 IL Practitioner - Nurse Practitioner 2567529811 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3333 W Deyoung St
Marion, IL 62959-5884
Phone (618) 998-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.51 of 100Reported as group
Quality
49.04
Promoting interoperability
95
Improvement activities
40
Cost
69.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209008417ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Specialty Clinic, Inc. Nurse Practitioner CurrentSince Jun 1, 2023 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. Interventional Cardiology Current Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. Interventional Cardiology CurrentSince Jun 1, 2023 Accepting new patients
Deaconess Illinois Clinic, Inc Past Accepting new patients
Ohio Valley Heartcare Inc Past Accepting new patients

Locations

517 N Main St
Anna, IL 62906
Phone (618) 833-2295

303 S Commercial St
Harrisburg, IL 62946
Phone (618) 767-6050

3333 W Deyoung St
Marion, IL 62959
Phone (618) 998-7020

3331 W Deyoung St
Marion, IL 62959
Phone (618) 985-9140

818 E Broadway St
Sparta, IL 62286
Phone (618) 443-2177

509 Hamacher St
Waterloo, IL 62298
Phone (618) 939-3939

Interoperability endpoints

  • Direct secure messaging: cgustavison15611@sih.direct-ci.com
  • Direct secure messaging: cgustavi@yourcarecommunity.org

Organizations & group practices 6

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 9

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": "1232928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1508004706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 W OAK ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011464",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAVISON",
        "first_name": "CASEY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-26",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209008417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSR",
            "identifier": "71002863B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "71002863A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cgustavison15611@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "409 W Oak St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.