Maria M. Gustilo, M.D.
Individual provider Active NPI Psychiatry Physician · Osawatomie, KS
NPI 1962557421 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1962557421
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 0420853 (KS)
- Practice address
- 500 State Hospital Dr
Osawatomie, KS 66064-1813 - Phone
- (913) 755-7000
- Fax
- (913) 755-7127
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Owned or controlled facilities with NPI records 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Adair Acute Care at Osawatomie State Hospital |
Hospital | W-2 Managing Employee | Jul 15, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050407000968 | KS | Practitioner - Psychiatry | 6901853233 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0420853 | KS | MD | Psychiatry Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 0420853 | KS | Yes |
Addresses
Primary practice location
500 State Hospital Dr
Osawatomie, KS 66064-1813
Mailing address
500 State Hospital Dr
Osawatomie, KS 66064-1813
Phone (913) 755-7000
Other providers in Osawatomie, KS
- Sara Graves
- Samantha Ann Greenstein
- Cassi Renee Grimes
- Kathleen M. Grint
- Mariah Christine Guilfoyle
- Mary Harber
- Thyrone A. Harriman
- Alyson Lyn Hastings
- Laura Lea Henness
- Michael Patrick Herriges
All providers in Osawatomie, KS · Psychiatry Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.