MR. ZACHARY R GUSTAVISON (NPI# 1316108970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316108970 |
| Entity Type | Individual |
| Full Name | MR. ZACHARY R GUSTAVISON |
| Credential | PA-C |
| Practice Address |
605 N 12th St Mount Vernon IL 62864-2857 |
| Mailing Address |
200 Corporate Blvd Lafayette LA 70508-3870 |
| Practice Telephone | 5862632601 |
| Mailing Telephone | 8008939698 |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2019-08-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085-003467 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 5601005286 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Saint Anthonys Way, Alton, IL 620024568 | 6184652571 | 6184654569 |
| Street Address |
605 N 12TH ST |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-2857 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447266507 | Prince B Oliver Jr. | Anesthesiology | 605 N 12th St, Mount Vernon, IL 62864-2857 | 2006-07-31 |
| 1629367578 | Midwest Emergency Good Samaritan, Inc | Emergency Medicine | 605 N 12th St, Mount Vernon, IL 62864-2857 | 2011-03-31 |
| 1528394335 | Katelyn Marie Lewis | Speech-Language Pathologist | 605 N 12th St, Mount Vernon, IL 62864-2857 | 2009-10-29 |
| 1538398680 | Michael Ambrose | Chiropractor | 605 N 12th St, Mount Vernon, IL 62864 | 2009-07-10 |
| 1295975837 | Sterling Emergency Physicians of Illinois, S.c | Physician Assistant | 605 N 12th St, Mount Vernon, IL 62864-2857 | 2009-02-23 |
| 1871773879 | Thomas J. Cain | Nurse Anesthetist, Certified Registered | 605 N 12th St, Mount Vernon, IL 62864-2857 | 2007-11-07 |
| 1508063405 | Advanced Internal Medicine, LLC | Internal Medicine | 605 N 12th St, Hospitalist Office, Mount Vernon, IL 62864-2857 | 2007-07-02 |
| 1215142310 | Douglas Elner Frankel | Emergency Medicine | 605 N 12th St, Mount Vernon, IL 62864-2857 | 2007-05-11 |
| 1659416923 | Amanda M Brown | Physical Therapist | 605 N 12th St, Mount Vernon, IL 62864-2857 | 2007-02-21 |
| 1184769465 | Justine Thole | Speech-Language Pathologist | 605 N 12th St, Mount Vernon, IL 62864-2857 | 2007-02-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982249124 | Leticia B Barrientos | Physician Assistant | 472 Gramatan Ave Apt Bb4, Mount Vernon, NY 10552-2979 | 2019-11-12 |
| 1396390522 | Elizabeth Kuriakose | Physician Assistant | 203 Gramatan Ave Ste A, Mount Vernon, NY 10550-1291 | 2019-08-05 |
| 1174941728 | Lyndsey Switzer | Physician Assistant | 1600 Continental Pl Ste 101, Mount Vernon, WA 98273-5607 | 2014-04-01 |
| 1255585311 | Pamela Welch | Physician Assistant | 5754 Farm Road 21, Mount Vernon, TX 75457-7749 | 2008-11-15 |
| 1881857787 | Telesforo Llamas Jr. | Physician Assistant | 2 Fisher Dr, Apartment 607, Mount Vernon, NY 10552-3666 | 2008-07-10 |
| 1275712614 | Naima R Abdus-salaam | Physician Assistant | 495 N Fulton Ave, Mount Vernon, NY 10552-1909 | 2007-11-02 |
| 1316006588 | Lee Barry Leavelle | Physician Assistant | 107 W 4th Street, Mount Vernon Neighborhood Health Ctr, Mount Vernon, NY 10550 | 2006-12-06 |
| 1215096359 | Patricia Taddeo | Physician Assistant | 107 West Fourth St, Mount Vernon Neighborhood Health Center, Mount Vernon, NY 10550 | 2006-12-06 |
| 1831270065 | Rochelle A, Trussell | Physician Assistant | 1400 E. Kincaid St, Mount Vernon, WA 98274-4127 | 2006-10-17 |
| 1750497061 | Shirley Dallmier | Physician Assistant | 3307 Broadway St Ste 130, Physician Rural Health Clinic of Jefferson County, Mount Vernon, IL 62864-2387 | 2006-08-21 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.