Active NPI
Gregory Gustafson
- Radiation Oncology Physician
- Troy, MI
National Provider Identifier
1922068923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 4301051606
- Practice address
- 44201 Dequindre Rd
Troy, MI 48085-1117 - Phone
- (248) 964-3073
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 4301051606 | MI | Primary |
Addresses
Primary practice location
44201 Dequindre Rd
Troy, MI 48085-1117
Mailing address
3601 W 13 Mile Rd
400-FSC/PCS
Royal Oak, MI 48073-6712
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2766814 | Medicaid | MI | |
| 320F362430 | Other | MI | BCBSM |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ggustafson7212@direct.beaumont.edu |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Radiation Oncology
- Education
- Wayne State University School of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
28100 Grand River Ave
Farmington Hills, MI 48336-5970
3555 W 13 Mile Rd
Royal Oak, MI 48073-6710
3577 W 13 Mile Rd
Royal Oak, MI 48073-6710
3581 W 13 Mile Rd BCC
Beaumont Breast Care Center
Royal Oak, MI 48073-6710
Phone (248) 551-3300
44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-0535
Hospital & facility affiliations
- Beaumont Hospital, Troy
- Beaumont Hospital Royal Oak
- Beaumont Hospital - Farmington Hills
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.37 of 100
- Quality
- 66.73
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 70.98
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301051606 | MI | MD | Radiation Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beaumont Medical Group- Specialty Services | Current | Accepting new patients | |
| Premier Radiation Oncology Services, P.L.C. | Radiation Oncology | Past | Accepting new patients |
Locations
28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320
3601 W 13 Mile Rd
#400
Royal Oak, MI 48073
Phone (248) 423-2481
3601 W 13 Mile Rd
Royal Oak, MI 48073
44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255
Interoperability endpoints
- ggustafson1456010@epic00.shdirect.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.
-
- Surgery Physician
- Royal Oak, MI
- NPI 1578072906
-
- Radiation Oncology Physician
- Royal Oak, MI
- NPI 1477654028
Hospital & facility affiliations 11
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Farmington Hills, MI
- NPI 1336183367
-
- General Acute Care Hospital
- Troy, MI
- NPI 1306825997
-
- General Acute Care Hospital
- Royal Oak, MI
- NPI 1689653305
-
- General Acute Care Hospital
- Grosse Pointe, MI
- NPI 1932396017
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603238400000",
"number": "1922068923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 W 13 MILE RD",
"address_2": "400-FSC/PCS",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480736712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44201 DEQUINDRE RD",
"city": "TROY",
"state": "MI",
"postal_code": "480851117",
"telephone_number": "248-964-3073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "GREGORY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2020-10-21",
"certification_date": "2020-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "MI",
"license": "4301051606",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2766814",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "320F362430",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ggustafson7212@direct.beaumont.edu",
"affiliation": "N",
"address_1": "44201 Dequindre Rd",
"city": "Troy",
"state": "MI",
"country_code": "US",
"postal_code": "480851117",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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.
- 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.