Evan Gustavsen, PT, DPT in Boise, ID - Medicare Physical Therapy Provider

Evan Gustavsen, PT, DPT is a medicare enrolled "Physical Therapist" provider in Boise, Idaho. She graduated from medical school in 2019 and has 5 years of diverse experience with area of expertise as Physical Therapy. She is a member of the group practice Physical Therapy 180 Llc and her current practice location is 5909 W State St, Boise, Idaho. You can reach out to her office (for appointments etc.) via phone at (208) 343-7700.

Evan Gustavsen is licensed to practice in Idaho (license number 6426) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1932754496.

Contact Information

	Evan Gustavsen, PT, DPT
	5909 W State St, Boise, ID 83703-3039
	(208) 343-7700
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Evan Gustavsen
Gender	Female
Speciality	Physical Therapy
Experience	5 Years
Location	5909 W State St, Boise, Idaho
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Evan Gustavsen graduated from medical school in 2019

NPI Data:

NPI Number: 1932754496
Provider Enumeration Date: 08/01/2019
Last Update Date: 08/02/2019

Medicare PECOS Information:

PECOS PAC ID: 8527397918
Enrollment ID: I20190910003291

Medical Identifiers

Medical identifiers for Evan Gustavsen such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1932754496	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
225100000X	Physical Therapist	6426 (Idaho)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Physical Therapy 180 Llc	9830422955	2

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. Evan Gustavsen allows following entities to bill medicare on her behalf.

Provider Name	Sawtooth Physical Therapy
Provider Type	Part B Supplier - Physical/occupational Therapy Group In Private Practice
Provider Identifiers	NPI Number: 1013206002 PECOS PAC ID: 1759552961 Enrollment ID: O20110920000507

Provider Name	Physical Therapy 180 Llc
Provider Type	Part B Supplier - Physical/occupational Therapy Group In Private Practice
Provider Identifiers	NPI Number: 1669696910 PECOS PAC ID: 9830422955 Enrollment ID: O20190605000354

Provider Name	Csrm Llc
Provider Type	Part B Supplier - Physical/occupational Therapy Group In Private Practice
Provider Identifiers	NPI Number: 1669132353 PECOS PAC ID: 4789078312 Enrollment ID: O20220224002990

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. Evan Gustavsen 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
Evan Gustavsen, PT, DPT 622 W Wyndemere Dr, Boise, ID 83702-1359 Ph: (208) 283-9592	Evan Gustavsen, PT, DPT 5909 W State St, Boise, ID 83703-3039 Ph: (208) 343-7700

Reviews and Comments

Physical Therapist in Boise, ID

Mrs. Dianne Denise Nelson, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1130 Allumbaugh St, Boise, ID 83704 Phone: 208-854-8517
Peter H Kolb, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 901 N Curtis Rd Ste 204, Boise, ID 83706 Phone: 208-367-3315 Fax: 208-367-2674
Melissa Pirtle, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 703 S Americana Blvd, Suite 130, Boise, ID 83702 Phone: 208-706-7530 Fax: 208-706-7531
Kyle Aaron Holbrook, PT, DPT, NCS Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 600 N Robbins Rd, Boise, ID 83702 Phone: 208-489-4444
Rebecca Wensel, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 190 E Bannock St, Boise, ID 83712 Phone: 208-381-2138
Bridget Gilbertson, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2931 N Maywood Ave, Boise, ID 83704 Phone: 385-498-1740
Idaho Physical Therapy Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1175 E Parkcenter Blvd, Ste 101, Boise, ID 83706 Phone: 208-367-1010

Evan Gustavsen, PT, DPT - Medicare Physical Therapist in Boise, ID