NPIMap

Individual provider Active NPI

Nicholas Gustafson

  • Hematology & Oncology Physician
  • Sheboygan, WI
National Provider Identifier
1508286386
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
72979 Issued in WI
Practice address
1222 N 23Rd St
Sheboygan, WI 53081-3171
Phone
(920) 457-6800
NPI assigned
Apr 21, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 02005360A IN
Hematology & Oncology Physician 207RH0003X 72979 WI Primary

Addresses

Primary practice location

1222 N 23Rd St
Sheboygan, WI 53081-3171

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Other identifiers 1

IdentifierTypeStateIssuer
100139705MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ngustafson294070@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20201229000344 WI Practitioner - Hematology/Oncology 8426343559 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Chicago College of Osteopathy, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Health Care Central, Inc.Group PAC ID 4688583677, 10 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

1222 N 23Rd St
Sheboygan, WI 53081-3171
Phone (920) 457-6800

Hospital & facility affiliations

  • Aurora Medical Center Sheboygan County Hospital, Sheboygan, WI, CCN 520035
  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
72979WIMDHematology & Oncology Physician
02005360AINMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Health Care Metro, Inc. CurrentSince Feb 1, 2022 Accepting new patients
Aurora Health Care Central, Inc. CurrentSince Jan 18, 2021 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jan 18, 2021 Accepting new patients
Aurora Medical Group, Inc. Current Accepting new patients
Aurora Health Care Central, Inc. CurrentSince Jan 18, 2021 Accepting new patients
Aurora Health Care Metro, Inc. Hematology & Oncology CurrentSince Feb 1, 2022 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jan 18, 2021 Accepting new patients

Locations

975 Port Washington Rd
Grafton, WI 53024
Phone (262) 329-1000

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

901 Reed St
Plymouth, WI 53073
Phone (920) 451-5579

1222 N 23rd St
Sheboygan, WI 53081
Phone (920) 457-4461

Interoperability endpoints

  • Direct secure messaging: ngustafson294070@direct.myadvocateaurora.org

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": "1398038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1508286386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 N 23RD ST",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813171",
            "telephone_number": "920-457-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-21",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "02005360A",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WI",
            "license": "72979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100139705",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ngustafson294070@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1222 N 23rd St",
            "city": "Sheboygan",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530813171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1222 N 23rd St",
            "city": "Sheboygan",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530813171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

Verify at the official NPI Registry.