Individual provider Active NPI

Cindy R Gustafson, FNP

  • Nurse Practitioner
  • Midland, MI
National Provider Identifier
1619112281
Registry record updated Dec 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704178573 Issued in MI
Practice address
4005 Orchard Dr
Midland, MI 48670-0001
Phone
(989) 839-3000
NPI assigned
Dec 10, 2008
Last updated
Dec 10, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2008

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 4704178573 MI Primary

Addresses

Primary practice location

4005 Orchard Dr
Midland, MI 48670-0001

Mailing address

4005 Orchard Dr
Midland, MI 48670-0001

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090318000116 MI Practitioner - Nurse Practitioner 1254498314 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704178573MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Midland CurrentSince Jan 18, 2016 Accepting new patients
Renal Associates of Mid-Michigan PC CurrentSince Oct 1, 2018 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Jan 18, 2016 Accepting new patients

Locations

300 E Warwick Dr
Alma, MI 48801
Phone (989) 463-0104

602 Beech St
Ste 3100
Clare, MI 48617
Phone (989) 802-5020

815 N Clare Ave
Harrison, MI 48625
Phone (989) 539-4096

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

415 W Wackerly St
Midland, MI 48640
Phone (989) 837-6505

4005 Orch Dr
Midland, MI 48670
Phone (989) 839-3100

4201 Campus Ridge Dr
Ste 3000
Midland, MI 48640
Phone (989) 488-5450

4100 Campus Ridge Dr
Midland, MI 48640
Phone (989) 488-5450

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

1221 South Dr
Mt Pleasant, MI 48858
Phone (989) 772-6700

Interoperability endpoints

  • Direct secure messaging: cgustafson5886@mymichiganhealth.midirect.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228867200000",
    "number": "1619112281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 ORCHARD DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486700001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 ORCHARD DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486700001",
            "telephone_number": "989-839-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "CINDY",
        "middle_name": "R",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-10",
        "last_updated": "2008-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704178573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.