Individual provider Active NPI

Susan E Gustafson, CRNP

  • Family Nurse Practitioner
  • Pittsburgh, PA
National Provider Identifier
1760616759
Registry record updated May 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP010257 Issued in PA
Practice address
634 Alpha Dr
Suite 600
Pittsburgh, PA 15238-2802
Phone
(610) 892-8991
Fax
(610) 892-8991
NPI assigned
May 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP010257 PA Primary

Addresses

Primary practice location

634 Alpha Dr
Suite 600
Pittsburgh, PA 15238-2802

Mailing address

634 Alpha Dr
Suite 600
Pittsburgh, PA 15238-2802
Phone (610) 892-8991

Other identifiers 1

IdentifierTypeStateIssuer
1022918120001MedicaidPA

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP010257PAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1241568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399939200000",
    "number": "1760616759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "634 ALPHA DR",
            "address_2": "SUITE 600",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152382802",
            "telephone_number": "610-892-8991",
            "fax_number": "610-892-8991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "634 ALPHA DR",
            "address_2": "SUITE 600",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152382802",
            "telephone_number": "610-892-8991",
            "fax_number": "610-892-8991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "SUSAN",
        "middle_name": "E",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-06",
        "last_updated": "2014-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP010257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022918120001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburgh, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.