Individual provider Active NPI

Davor Gusak, DO

  • Emergency Medicine Physician
  • Jackson, MI
National Provider Identifier
1851702823
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
02005314A Issued in IN
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 788-4800
Fax
(517) 817-7050
NPI assigned
May 13, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 02005314A IN Primary

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

205 N East Ave
Jackson, MI 49201-1753
Phone (517) 788-4800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20180404000044 IN Practitioner - Emergency Medicine 1850516071 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarksville Emergency Group PCGroup PAC ID 6507277423, 149 clinicians

Practice addresses (Care Compare)

3500 Franciscan Way
Franciscan Health Michigan City
Michigan City, IN 46360-0021
Phone (219) 879-8511

Hospital & facility affiliations

  • Franciscan Health Michigan City Hospital, Michigan City, IN, CCN 150015

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Clarksville Physician Services PC CurrentSince Nov 21, 2023 Accepting new patients
Clarksville Emergency Group, PC Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients

Locations

770 Indian Boundary Rd
Chesterton, IN 46304
Phone (219) 595-0630

1141 Hospital Dr NW
Corydon, IN 47112
Phone (812) 738-7830

3500 Franciscan Way
Michigan City, IN 46360
Phone (219) 852-1524

Interoperability endpoints

  • Direct secure messaging: dgusak397313@direct.franciscanalliance.org

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1851702823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4800",
            "fax_number": "517-817-7050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4800",
            "fax_number": "517-817-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSAK",
        "first_name": "DAVOR",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-13",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02005314A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.