Individual provider Active NPI

Troy Charles Gustafson, D.C.

  • Chiropractor
  • Tucson, AZ
National Provider Identifier
1881623064
Registry record updated Jul 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
AZ4859 Issued in AZ
Practice address
5601 N Oracle Rd
Tucson, AZ 85704-3980
Phone
(520) 742-9395
Fax
(520) 742-0365
NPI assigned
Jul 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X AZ4859 AZ Primary
Chiropractor 111N00000X A05548 IA

Addresses

Primary practice location

5601 N Oracle Rd
Tucson, AZ 85704-3980

Mailing address

5601 N Oracle Rd
Tucson, AZ 85704-3980
Phone (520) 742-9395

Other identifiers 1

IdentifierTypeStateIssuer
AZ0236370OtherAZBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060817000134 AZ Practitioner - Chiropractic 9133122948 Practice locations: Tucson, AZ

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5601 N Oracle Rd
Tucson, AZ 85704-3980
Phone (520) 742-9395

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AZ4859AZMDChiropractor
A05548IAMDChiropractor
4859AZMDOccupational Therapist

Interoperability endpoints

  • Direct secure messaging: tgustafson@abhc0001.direct.chirotouch.md

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341446400000",
    "number": "1881623064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 N ORACLE RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857043980",
            "telephone_number": "520-742-9395",
            "fax_number": "520-742-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 N ORACLE RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857043980",
            "telephone_number": "520-742-9395",
            "fax_number": "520-742-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "TROY",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-01",
        "last_updated": "2012-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "AZ4859",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "A05548",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0236370",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.