NPIMap

Individual provider Active NPI

George Allen Gustafson, M.D.

  • Specialist
  • Redlands, CA
National Provider Identifier
1851310825
Registry record updated Jan 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G24086 Issued in CA
Practice address
1901 West Lugonia Ave. Ste. 210
Redlands, CA 92374
Phone
(909) 557-1600
Fax
(909) 557-1740
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G24086 CA Primary
Orthopaedic Surgery Physician 207X00000X G24086 CA

Addresses

Primary practice location

1901 West Lugonia Ave. Ste. 210
Redlands, CA 92374

Mailing address

1901 West Lugonia Ave. Ste. 210
Redlands, CA 92374
Phone (909) 557-1600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040527001090 CA Practitioner - Orthopedic Surgery 7810988136 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Loma Linda University School of Medicine, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1901 W Lugonia Ave
Suite 120 130
Redlands, CA 92374-9703
Phone (909) 557-1600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G24086CAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Bernardino Medical Orthopaedic Group, Inc. Orthopaedic Surgery Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Doctors Hospital of Riverside LLC Past Accepting new patients
Hemet Valley Medical Center Past Accepting new patients
San Gorgonio Memorial Hospital Past Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
Community Hospital of San Bernardino Past Accepting new patients
Dignity Health Past Accepting new patients
Redlands Community Hospital Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420156800000",
    "number": "1851310825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 WEST LUGONIA AVE. STE. 210",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "92374",
            "telephone_number": "909-557-1600",
            "fax_number": "909-557-1740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 WEST LUGONIA AVE. STE. 210",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "92374",
            "telephone_number": "909-557-1600",
            "fax_number": "909-557-1740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "GEORGE",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G24086",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G24086",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

Verify at the official NPI Registry.