Gary M Pusateri, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

29938-020 Issued in WI

Practice address

3144 Vanzile Rd
Crandon, WI 54520-8149

Phone

(715) 478-5180

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gary.pusateri@schc.directbygreenway.com
• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73753

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.

• Sokaogon Chippewa Community

  • Federally Qualified Health Center (FQHC)
  • Crandon, WI
  • NPI 1033115456
  Medicare reassignment NPD

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1851383525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "E23570 POW WOW TRAIL",
            "city": "WATERSMEET",
            "state": "MI",
            "postal_code": "49969",
            "telephone_number": "906-358-4588",
            "fax_number": "906-358-4588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3144 VANZILE RD",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208149",
            "telephone_number": "715-478-5180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUSATERI",
        "first_name": "GARY",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WI",
            "license": "29938-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31543400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasee Novak
• Audra A Olson, RPH
• Paul Linderud
• Rebecca D Perry, MD
• William R Pierre, OD TPA
• Robert Lee Quade, RN
• Kristen Radloff, FNP, APNP
• Katherine Richlen, RD
• Kirk R Ritchie, DDS
• Christina Gabriella Ritzer, RDN LD CD

• General Practice Physician in Crandon, WI
• Providers in Crandon, WI by specialty
• General Practice Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.