1. Home
  2. Directory
  3. Tennessee
  4. Cleveland
  5. Surgery
  6. NPI Profile

DR. JACQUELINE JEANETTE CARTER GUSTAFSON MD
NPI 1023209632
Surgery in Cleveland, TN

Active since August 08, 2007PECOS EnrolledAccepts Medicare Assignment
76.66/100
CMS Quality Rating
2700 WESTSIDE DR NW STE 204, CLEVELAND, TN 37312(423) 244-9270(423) 244-9255 Get Directions Write a Review

NPPES record last updated: August 20, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Aug 20, 2024, Jan 17, 2022 (2 updates tracked since 2022).

About Dr. Jacqueline Jeanette Carter Gustafson Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACQUELINE JEANETTE CARTER GUSTAFSON MD (NPI 1023209632) is an individual surgery provider in Cleveland, Tennessee, licensed in Tennessee (MD67660) and active in the NPI registry since August 2007. She is enrolled in Medicare PECOS, is affiliated with Tristar Southern Hills Medical Center, and maintains a secondary practice location in Smyrna.

NPPES Registry Identity

NPI1023209632
Entity TypeIndividualFemale
Primary Taxonomy208600000X
Provider Legal NameDR. JACQUELINE JEANETTE CARTER GUSTAFSONCredential: MD
Location Address2700 WESTSIDE DR NW STE 204Cleveland, TN 37312-3682
Mailing Address2700 Westside Dr Nw Ste 204Cleveland, TN 37312-3682 · (423) 244-9270 · Fax (423) 244-9255
Phone(423) 244-9270
Fax(423) 244-9255
Sole ProprietorNo
Medical School CMSLoma Linda University School Of MedicineGraduated 2005
Enumeration DateAugust 8, 2007
Last NPPES UpdateAugust 20, 20242 updates tracked since enumeration
NPPES CertifiedAugust 20, 2024
✔ NPI 1023209632 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in TN · MD67660
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
2700 WESTSIDE DR NW STE 204, Cleveland, TN 37312
Open in Google Maps ↗

Other Names 1

Former Name (1)Jacqueline Carter Md

Secondary Practice Location 1

Location 1515 Stonecrest Pkwy Ste 230Smyrna, TN 37167-6829 · Phone (615) 223-9935

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Jacqueline Jeanette Carter Gustafson Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1456522499
PECOS Enrollment IDI20241031002403
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

5

Medicare enrollment records show Jacqueline Carter Gustafson reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Tennessee Oncology
25 mi
Diagnostic Radiology
1032 MCCALLIE AVE STE 200
Chattanooga, TN 37403
  • Reassigned Medicare billing, Tennessee enrollment
  • 464 clinicians in this Medicare group
NPI 1912623364 (423) 708-6495
Privia Medical Group Tennessee LLC
128 mi
Family Medicine
1 VANTAGE WAY STE C240
Nashville, TN 37228
  • Reassigned Medicare billing, Tennessee enrollment
  • 173 clinicians in this Medicare group
NPI 1376110858 (571) 982-6636
The Surgical Clinic PLLC
128 mi
Surgery
410 42ND AVE N STE 400
Nashville, TN 37209
  • Reassigned Medicare billing, Tennessee enrollment
  • 48 clinicians in this Medicare group
NPI 1417983099 (615) 346-6213
Orohealth Corporation A Non Profit Healthcare System
2,026 mi
Family Medicine
2767 OLIVE HWY
Oroville, CA 95966
  • Reassigned Medicare billing, California enrollment
  • 267 clinicians in this Medicare group
NPI 1013933167 (530) 533-8500
Enloe Medical Center
2,041 mi
Surgery
1600 ESPLANADE, SUITE C
Chico, CA 95926
  • Reassigned Medicare billing, California enrollment
  • 184 clinicians in this Medicare group
NPI 1477975613 (530) 332-7300

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Tristar Southern Hills Medical Center

Acute Care Hospitals · Nashville, TN
3/5 CMS rating
OwnershipProprietary
CMS Certification Number440197
Location391 Wallace RdNashville, TN 37211 · Davidson County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37312 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.53 typical visit price
range $52.64 – $160.89
Typical copayment $20.38 (range $13.16 – $40.22)
Most-billed visit code 99203
Established Patient
$66.01 typical visit price
range $16.72 – $131.41
Typical copayment $16.50 (range $4.18 – $32.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

76.66/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality58.21
Promoting Interoperability100
Improvement Activities40
Cost56.9

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JAMES F HART D.O.
Psychiatry & Neurology (Psychiatry)
2700 WESTSIDE DR NW STE 204
CLEVELAND, TN 37312
Bradley County (423) 728-1667

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacqueline Carter Gustafson's NPI number?

The NPI number for Jacqueline Carter Gustafson is 1023209632. It was assigned to this individual provider in the NPPES registry on August 8, 2007. The provider is also known as Jacqueline Carter MD.

Where is Jacqueline Carter Gustafson located?

Jacqueline Carter Gustafson practices at 2700 Westside Dr NW Ste 204, Cleveland, TN 37312. The listed phone number is (423) 244-9270.

What is Jacqueline Carter Gustafson's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Jacqueline Carter Gustafson enrolled in Medicare?

Yes. Jacqueline Carter Gustafson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jacqueline Carter Gustafson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacqueline Carter Gustafson reassigns Medicare benefits to 5 organizations: Tennessee Oncology (Chattanooga, TN), Privia Medical Group Tennessee LLC (Nashville, TN), The Surgical Clinic PLLC (Nashville, TN), Orohealth Corporation A Non Profit Healthcare System (Oroville, CA) and Enloe Medical Center (Chico, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacqueline Carter Gustafson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jacqueline Carter Gustafson accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 4 other insurers list Jacqueline Carter Gustafson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Jacqueline Carter Gustafson affiliated with any hospitals?

According to CMS data, Jacqueline Carter Gustafson is affiliated with Tristar Southern Hills Medical Center.

When was this NPI record last updated?

The NPPES record for Jacqueline Carter Gustafson was last updated on August 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.