NPIMap

Individual provider Active NPI

Jonathan Gusdorff, D.O.

  • Diagnostic Radiology Physician
  • Havertown, PA
National Provider Identifier
1891792255
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
OS010370L Issued in PA
Practice address
1305 W Chester Pike
Havertown, PA 19083-2929
Phone
(610) 482-4949
Fax
(610) 482-4950
NPI assigned
Jun 30, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085N0700X 02005865A IN
Diagnostic Radiology Physician 2085R0202X 4519 OK
Specialist 174400000X OS010370L PA
Diagnostic Radiology Physician 2085R0202X OS010370L PA Primary

Addresses

Primary practice location

1305 W Chester Pike
Havertown, PA 19083-2929

Mailing address

1305 W Chester Pike
Havertown, PA 19083-2929
Phone (610) 482-4949

Other identifiers 1

IdentifierTypeStateIssuer
200114580AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20191209001488 IN Practitioner - Diagnostic Radiology 0446235832 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Philadelphia College of Osteopathic Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians
Indiana University Radiology Associates IncGroup PAC ID 7315922267, 213 clinicians

Practice addresses (Care Compare)

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

Hospital & facility affiliations

  • Indiana University Health Hospital, Indianapolis, IN, CCN 150056
  • Indiana University Health Ball Memorial Hospital Hospital, Muncie, IN, CCN 150089
  • Indiana University Health Bloomington Hospital Hospital, Bloomington, IN, CCN 150051
  • Cameron Health Hospital, Angola, IN, CCN 151315
  • Iu Health West Hospital Hospital, Avon, IN, CCN 150158

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
02005865AINMDNeuroradiology Physician
4519OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Health Medical Group, LLC Multi-Specialty CurrentSince Oct 1, 2025 Accepting new patients
Indiana University Radiology Associates, Inc. Multi-Specialty CurrentSince Dec 9, 2019 Accepting new patients
Pawhuska IHS Pharmacy Past Accepting new patients
Rittenhouse Imaging Center, LLC Multi-Specialty Past Accepting new patients
Wewoka Indian Health Multi-Specialty Past Accepting new patients
Delaware Open MRI Radiology Associates LLC Multi-Specialty Past Accepting new patients
Cherokee Nation Multi-Specialty PastSince Mar 1, 2021 Accepting new patients
Ctca Physicans Group of Oklahoma, Inc Specialist Past Accepting new patients
Diagnostic Imaging Associates Inc Multi-Specialty Past Accepting new patients
Cherokee Nation Past Accepting new patients
Tristate Imaging Consultants, LLC Multi-Specialty Past Accepting new patients
Jeanes Radiology Associates LLC Multi-Specialty Past Accepting new patients

Locations

5924 Reliable Pkwy
Chicago, IL 60686

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

1701 Senate Blvd
#C6
Indianapolis, IN 46202
Phone (317) 962-9000

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/

Organizations & group practices 12

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 5

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": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1891792255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 W CHESTER PIKE",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190832929",
            "telephone_number": "610-482-4949",
            "fax_number": "610-482-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W CHESTER PIKE",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190832929",
            "telephone_number": "610-482-4949",
            "fax_number": "610-482-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSDORFF",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": "IN",
            "license": "02005865A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "4519",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "OS010370L",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "OS010370L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200114580A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Havertown, PA

Sources for this page

Verify at the official NPI Registry.