Jill Reena Gustafson, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

56670 Issued in ID

Practice address

4948 W Kootenai St Ste 100
Boise, ID 83705-2002

Phone

(208) 510-0261

Fax

(208) 225-4243

NPI assigned

Sep 19, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14835/brand/1/csg/1/fhir/r4

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.

• Boise Womens Health & Birth Center

  • Birthing Clinic/Center
  • Boise, ID
  • NPI 1780014753
  NPD (past)

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

{
    "created_epoch": "1505779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646784000000",
    "number": "1992224166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4948 W KOOTENAI ST STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837052002",
            "telephone_number": "208-510-0261",
            "fax_number": "208-225-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4948 W KOOTENAI ST STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837052002",
            "telephone_number": "208-510-0261",
            "fax_number": "208-225-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "JILL",
        "middle_name": "REENA",
        "credential": "CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-19",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "56670",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "ID",
            "license": "56670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayanna Gunther
• Animesh Gupta
• Pranati Pravin Gupte
• Michael L Gurr, RT
• Brandi Gustafson, DPT
• Gustavel Orthopedics PLLC
• Michael J Gustavel, MD
• Terry L Gustavel, D.D.S.
• Evan Gustavsen, PT, DPT
• Jill Guth, BA

• Advanced Practice Midwife in Boise, ID
• Providers in Boise, ID by specialty
• Advanced Practice Midwife in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.