Edward Ernest Gustavson, MD in Tahlequah, OK

Edward Ernest Gustavson, MD is a medicare enrolled "Pediatrics - Developmental - Behavioral Pediatrics" physician in Tahlequah, Oklahoma. His current practice location is 1310 E Boone St, Tahlequah, Oklahoma. You can reach out to his office (for appointments etc.) via phone at (918) 456-7700.

Edward Ernest Gustavson is licensed to practice in Oklahoma (license number 20370) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1386674182.

Contact Information

	Edward Ernest Gustavson, MD
	1310 E Boone St, Tahlequah, OK 74464-3338
	(918) 456-7700
	(918) 458-9314

Map and Direction

Physician's Profile

Full Name	Edward Ernest Gustavson
Gender	Male
Speciality	Pediatrics - Developmental - Behavioral Pediatrics
Location	1310 E Boone St, Tahlequah, Oklahoma
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1386674182
Provider Enumeration Date: 07/04/2006
Last Update Date: 07/29/2013

Medicare PECOS Information:

PECOS PAC ID: 9537187430
Enrollment ID: I20051109000720

Medical Identifiers

Medical identifiers for Edward Ernest Gustavson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1386674182	NPI	-	NPPES
100173510A	Medicaid	OK

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
2080P0006X	Pediatrics - Developmental - Behavioral Pediatrics	20370 (Oklahoma)	Primary
208000000X	Pediatrics	20370 (Oklahoma)	Secondary
2080N0001X	Pediatrics - Neonatal-perinatal Medicine	20370 (Oklahoma)	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Edward Ernest Gustavson allows following entities to bill medicare on his behalf.

Entity Name	Brookhaven Hospital Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1023064300 PECOS PAC ID: 9739288580 Enrollment ID: O20070620000421

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Edward Ernest Gustavson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Edward Ernest Gustavson, MD 1310 E Boone St, Tahlequah, OK 74464-3338 Ph: (918) 456-7700	Edward Ernest Gustavson, MD 1310 E Boone St, Tahlequah, OK 74464-3338 Ph: (918) 456-7700

Reviews and Comments

Pediatrics Doctors in Tahlequah, OK

Dr. Elaine Kennedy, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 100 S Bliss Ave, Pediatrics Clinic, Tahlequah, OK 74464 Phone: 918-458-3120
Dr. Gary Lynn Gaston, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1310 E Boone St, Tahlequah, OK 74464 Phone: 918-456-7700
Megan Melott Moss, DO Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1310 E Boone St, Tahlequah, OK 74464 Phone: 918-456-7700 Fax: 918-458-9314
Dr. Kimberly Ann Milford, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1500 E Downing St Ste 102, Tahlequah, OK 74464 Phone: 918-207-0773 Fax: 918-207-0774
Angel Javier Morales, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 100 S Bliss Ave, Tahlequah, OK 74464 Phone: 918-458-3100 Fax: 918-458-3279
Mrs. Kailey Madison Haley, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 19600 E Ross St, Tahlequah, OK 74464 Phone: 539-234-1000

Edward Ernest Gustavson, MD - Medicare Pediatrics in Tahlequah, OK