NPIMap

Organization Active NPI

Thomas C Gustafson

  • General Practice Physician
  • Seattle, WA
National Provider Identifier
1821213612
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
OP00001187 Issued in WA
Legal business name
THOMAS C GUSTAFSON
Practice address
1717 NW Market St
Seattle, WA 98107-5225
Phone
(206) 782-0500
Fax
(206) 782-0502
NPI assigned
Apr 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Authorized official

Name
Dr. Thomas Carl Gustafson, D.O.
Title
Physician
Phone
(206) 782-0500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X OP00001187 WA Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X AP30007148 WA

Addresses

Primary practice location

1717 NW Market St
Seattle, WA 98107-5225

Mailing address

1717 NW Market St
Seattle, WA 98107-5225
Phone (206) 782-0500

Other identifiers 2

IdentifierTypeStateIssuer
9647421MedicaidWA
1046325MedicaidWA

Other names 1

  • Market Street Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

1717 NW Market St
Seattle, WA 98107
Phone (206) 782-0500

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1821213612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 NW MARKET ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981075225",
            "telephone_number": "206-782-0500",
            "fax_number": "206-782-0502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 NW MARKET ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981075225",
            "telephone_number": "206-782-0500",
            "fax_number": "206-782-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS C GUSTAFSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "206-782-0500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "WA",
            "license": "OP00001187",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP30007148",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9647421",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1046325",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Market Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.