Tyler Joseph Gustafson, PHYSICIAN ASSISTANT
NPI 1609543255ActiveIndividual· Physician Assistant· Jamestown, NY
Physician Assistant (PHYSICIAN ASSISTANT) with Great Lakes Physician Practice PC, practicing in Jamestown, New York. Their prescriptions cost Medicare Part D more than their services did: $143,543 for 1,618 claims, against $19,733 paid for services in 2024. Lists Upmc Chautauqua at Wca as a hospital affiliation.
Overview
| NPI | 1609543255 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHYSICIAN ASSISTANT |
| Sole proprietor | Yes |
| NPI issued | Aug 23, 2021 |
| Last updated in NPPES | Feb 7, 2023 |
| Certified by provider | Feb 7, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 026970 | NY |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (NY) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 150 |
|---|---|
| Services billed | 576 across 20 procedure codes |
| Paid by Medicare | $19,733 |
Part D prescriptions in 2024
| Prescriptions (claims) | 1,618 · 3,140 30-day fills |
|---|---|
| Patients | 453 |
| Total drug cost | $143,543 |
| Generic share | 88% of claims |
Education and affiliations
| Graduation year | 2021 |
|---|---|
| Medicare specialty | Physician Assistant |
Medical group
- Great Lakes Physician Practice PCDunkirk, NY · 144 clinicians
Hospital affiliation
- Upmc Chautauqua at WcaJamestown, NY
Other facilities
- Willcare Chha (Buffalo)Home health agency · Amherst, NY
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 43 physician assistants in Jamestown · All physician assistants in New York