Jennifer Gustafson, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

0487 Issued in SD

Practice address

12057 411TH Ave
Claremont, SD 57432-7302

Phone

(605) 290-1163

NPI assigned

Nov 10, 2008

Last updated

Jan 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Modern Day Health Care Prof LLCGroup PAC ID 8325473507, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Modern Day Health Care Prof LLC

  • Multi-Specialty Clinic/Center
  • Aberdeen, SD
  • NPI 1851883540

  Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Prairie Independence PLLC

  • Occupational Therapist
  • Claremont, SD
  • NPI 1306597232
  Authorized official Same address or phone
• Fit for Life Chiropractic, LLC

  • Chiropractor
  • Brandon, SD
  • NPI 1740778422
  NPD
• Dakota Vascular Prof LLC

  dba Dakota Vascular

  • Vascular Surgery Physician
  • Sioux Falls, SD
  • NPI 1407591258
  NPD (past)

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

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1578717112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12057 411TH AVE",
            "city": "CLAREMONT",
            "state": "SD",
            "postal_code": "574327302",
            "telephone_number": "605-290-1163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12057 411TH AVE",
            "city": "CLAREMONT",
            "state": "SD",
            "postal_code": "574327302",
            "telephone_number": "605-290-1163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "JENNIFER",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-10",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SD",
            "license": "0487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION",
            "identifier": "1041741",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prairie Independence PLLC

• Occupational Therapist in Claremont, SD
• Providers in Claremont, SD by specialty
• Occupational Therapist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.