TY C. GULSTROM PA- C
NPI 1558306373
Physician Assistant in Mount Vernon, WA
About Ty C. Gulstrom Pa- C NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TY C. GULSTROM PA- C (NPI 1558306373) is an individual physician assistant in Mount Vernon, Washington, licensed in Washington (PA10004348) and active in the NPI registry since June 2006. He has opted out of Medicare through January 1, 2028 and remains eligible to order and refer.
NPPES Registry Identity
Specialties & Licenses 3
Other Identifiers 7
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Ty C. Gulstrom Pa- C has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 98274 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Other Providers at the Same Location NPPES 15
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MOUNT VERNON, WA 98274
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 Ty Gulstrom's NPI number?
The NPI number for Ty Gulstrom is 1558306373. It was assigned to this individual provider in the NPPES registry on June 17, 2006.
Where is Ty Gulstrom located?
Ty Gulstrom practices at 1400 E. Kincaid Street, Mount Vernon, WA 98274. The listed phone number is (360) 428-6434.
What is Ty Gulstrom's specialty?
The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.
Is Ty Gulstrom enrolled in Medicare?
No. Ty Gulstrom has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.
What insurance does Ty Gulstrom accept?
Health plans from PacificSource Health Plans and Providence Health Plan list Ty Gulstrom 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.
When was this NPI record last updated?
The NPPES record for Ty Gulstrom was last updated on February 18, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Ty C. Gulstrom, PA- C · NPI 1558306373
Physician Assistant physician in Mount Vernon, Washington. Individual provider, active in the CMS NPPES registry since June 17, 2006.
## Identity
- **NPI:** 1558306373 (Entity type: Individual)
- **Enumerated:** June 17, 2006
- **Primary specialty:** Physician Assistant · taxonomy 363A00000X
- **State license:** PA10004348 (Washington)
- **Sole proprietor:** No
## Practice location
- **Address:** 1400 E. KINCAID STREET, Mount Vernon, WA 98274-4127
- **Phone:** (360) 428-6434 · **Fax:** (360) 848-4233
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through January 1, 2028); services are provided under private contract
## Record status
- **NPPES last updated:** February 18, 2015
- **Other identifiers:** Other 0216864 (WA); Medicaid 8386484 (WA); Medicare UPIN GUL1972 (WA); and 4 more
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Source: [NPI Profile](https://npiprofile.com/npi/1558306373) · Data from the CMS NPPES public registry.