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SAMANTHA MADISON GUSTAFSON PAC
NPI 1376262246
Physician Assistant - Medical in Newport, WA

Active since August 24, 2022PECOS EnrolledAccepts Medicare Assignment
714 W PINE ST BLDG C, NEWPORT, WA 99156(509) 447-3139(509) 897-8597 Get Directions Write a Review

NPPES record last updated: June 10, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 10, 2024, Oct 16, 2023, Oct 5, 2023 and 1 more (4 updates tracked since 2022).

About Samantha Madison Gustafson Pac NPPES

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

SAMANTHA MADISON GUSTAFSON PAC (NPI 1376262246) is an individual medical provider in Newport, Washington, licensed in Washington (PA61488948) and active in the NPI registry since August 2022. She is enrolled in Medicare PECOS, is affiliated with Kootenai Health, and is a graduate of University Of Washington School Of Medicine (2023).

NPPES Registry Identity

NPI1376262246
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameSAMANTHA MADISON GUSTAFSONCredential: PAC
Location Address714 W PINE ST BLDG CNewport, WA 99156-9046
Mailing Address714 W Pine StNewport, WA 99156-9046 · (509) 447-3139 · Fax (509) 897-8597
Phone(509) 447-3139
Fax(509) 897-8597
Sole ProprietorNo
Medical School CMSUniversity Of Washington School Of MedicineGraduated 2023
Enumeration DateAugust 24, 2022
Last NPPES UpdateJune 10, 20244 updates tracked since enumeration
NPPES CertifiedJune 10, 2024
✔ NPI 1376262246 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in WA · PA61488948
714 W PINE ST BLDG C, Newport, WA 99156
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Samantha Madison Gustafson Pac 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 ID8325494131
PECOS Enrollment IDI20231031002311
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.

Hospital Affiliations CMS Care Compare 4

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

Kootenai Health

Acute Care Hospitals · Coeur D'alene, ID
4/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number130049
Location2003 Kootenai Health WayCoeur D'alene, ID 83814 · Kootenai County
Emergency services Birthing friendly

Bonner General Hospital

Critical Access Hospitals · Sandpoint, ID
OwnershipVoluntary non-profit - Private
CMS Certification Number131328
Location520 North Third AvenueSandpoint, ID 83864 · Bonner County
Emergency services

Providence Holy Family Hospital

Acute Care Hospitals · Spokane, WA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number500077
Location5633 North LidgerwoodSpokane, WA 99208 · Spokane County
Emergency services Birthing friendly

Newport Community Hospital

Critical Access Hospitals · Newport, WA
OwnershipGovernment - Hospital District or Authority
CMS Certification Number501310
Location714 West Pine StreetNewport, WA 99156 · Pend Oreille County
Emergency services

Other Providers at the Same Location NPPES 9

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

AARON REINKE MD
Family Medicine
714 W PINE ST BLDG C
NEWPORT, WA 99156
Pend Oreille County (509) 447-3139
JENNIFER STOUT LICSW
Social Worker (Clinical)
714 W PINE ST BLDG C
NEWPORT, WA 99156
Pend Oreille County (509) 447-3139
JAMES ALAN VANDERSLOOT DO
Obstetrics & Gynecology
714 W PINE ST BLDG C
NEWPORT, WA 99156
Pend Oreille County (509) 447-3139
KEVIN MCNAMEE MD
Family Medicine
714 W PINE ST BLDG C
NEWPORT, WA 99156
Pend Oreille County (509) 447-3139
ERIC LLOYD RENK PA-C
Physician Assistant (Medical)
714 W PINE ST BLDG C
NEWPORT, WA 99156
Pend Oreille County (509) 447-3139
BENEDICT BEAM PAC
Physician Assistant (Medical)
714 W PINE ST BLDG C
NEWPORT, WA 99156
Pend Oreille County (509) 447-3139
DR. TAYLOR KATHERINE STEWART MD
Family Medicine
714 W PINE ST BLDG C
NEWPORT, WA 99156
Pend Oreille County (509) 447-3139
LAURA REBECCA NOYES
Physician Assistant (Medical)
714 W PINE ST BLDG C
NEWPORT, WA 99156
Pend Oreille County (509) 447-3139

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 Samantha Gustafson's NPI number?

The NPI number for Samantha Gustafson is 1376262246. It was assigned to this individual provider in the NPPES registry on August 24, 2022.

Where is Samantha Gustafson located?

Samantha Gustafson practices at 714 W Pine St Bldg C, Newport, WA 99156. The listed phone number is (509) 447-3139.

What is Samantha Gustafson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Samantha Gustafson enrolled in Medicare?

Yes. Samantha 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.

What insurance does Samantha Gustafson accept?

Health plans from Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Samantha 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 Samantha Gustafson affiliated with any hospitals?

According to CMS data, Samantha Gustafson is affiliated with Kootenai Health, Bonner General Hospital, Providence Holy Family Hospital and Newport Community Hospital.

When was this NPI record last updated?

The NPPES record for Samantha Gustafson was last updated on June 10, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.