Active NPI
Megan J Gustafson, P.A.
- Physician Assistant
- Indianola, IA
National Provider Identifier
1659504694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001999
- Practice address
- 307 E Scenic Valley Ave
Indianola, IA 50125-4865 - Phone
- (515) 961-8448
- Fax
- (515) 643-9100
- NPI assigned
- Aug 25, 2009
- Last updated
- Jun 9, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001999 | IA | Primary |
Addresses
Primary practice location
307 E Scenic Valley Ave
Indianola, IA 50125-4865
Mailing address
PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 961-8448
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001999 | IA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boone County Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Critical Access Hospital
- Boone, IA
- NPI 1467434225
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433808000000",
"number": "1659504694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1475",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503051475",
"telephone_number": "515-961-8448",
"fax_number": "515-643-9100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 E SCENIC VALLEY AVE",
"city": "INDIANOLA",
"state": "IA",
"postal_code": "501254865",
"telephone_number": "515-961-8448",
"fax_number": "515-643-9100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "MEGAN",
"middle_name": "J",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-25",
"last_updated": "2015-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IA",
"license": "001999",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianola, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.