Active NPI 1568519635 Individual Practitioner Male Practitioner

Dr. Gustav Jaliang Lo , MD

General Practice • Petoskey, MI

Professional Overview & Biography Verified Profile Summary

Dr. Gustav Lo, MD is a registered healthcare professional specializing in General Practice in Petoskey, MI. Practice services are available at 116 W MITCHELL ST under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit, destruction of skin growth, complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

116 W Mitchell St

Petoskey, MI 497702324

Telephone 2313482828

Fax 2313489609

Associated Practice Facility / Clinic

🏢 Quick Care Family Medical Center Pc Facility NPI 1518145309

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Petoskey, MI

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 10.5 Yrs

State Avg: 29.4 Yrs

Regional Practice Density

2 Specialists

Practicing in Petoskey, MI (445 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

33.2% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2022)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	38	33	$106.18	$88.08
17000 Destruction of skin growth	15	14	$100.00	$49.66

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	63	56	$138.43	$86.71
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	40	34	$232.00	$116.04
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	18	18	$47.25	$7.34
17000 Destruction of skin growth	12	12	$100.00	$37.33

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,098	573	$105.01	$72.48
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	774	380	$154.92	$103.99
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	566	417	$20.00	$7.53
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	440	85	$7.51	$1.46
36415 Insertion of needle into vein for collection of blood sample	216	170	$8.00	$2.97
99202 New patient office or other outpatient visit, typically 20 minutes	208	208	$110.00	$74.20
G0444 Annual depression screening, 5 to 15 minutes	198	198	$21.59	$17.63
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	187	187	$120.00	$112.92
81001 Manual urinalysis test with examination using microscope, automated	146	119	$10.00	$3.05
71046 X-ray of chest, 2 views	142	121	$52.00	$31.15
J0696 Injection, ceftriaxone sodium, per 250 mg	125	22	$10.54	$0.57
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	119	119	$154.87	$105.25
83036 Hemoglobin A1C level	108	82	$20.00	$9.31
20611 Aspiration and/or injection of fluid large joint using ultrasound guidance	107	53	$140.00	$83.22
90674 Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free	102	102	$30.00	$28.88
G0008 Administration of influenza virus vaccine	101	101	$30.00	$16.09
J1885 Injection, ketorolac tromethamine, per 15 mg	74	17	$3.00	$0.52
93000 Routine ekg using at least 12 leads including interpretation and report	59	56	$40.25	$16.30
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	54	14	$180.00	$142.92
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	51	37	$35.00	$13.80
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	47	47	$72.00	$44.23
87426 Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus	42	42	$50.00	$35.33
76604 Ultrasound scan of chest	41	38	$140.00	$76.17
82962 Blood glucose (sugar) test performed by hand-held instrument	41	37	$10.00	$3.02
94618 Test for exercise-induced lung stress	40	31	$60.00	$32.86
87804 Detection test by immunoassay with direct visual observation for influenza virus	38	18	$26.25	$15.90
99201 New patient office or other outpatient visit, typically 10 minutes	35	35	$75.00	$44.73
96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less	27	24	$115.00	$67.31
73560 X-ray of knee, 1-2 views	26	25	$52.00	$30.61
74019 X-ray of abdomen, 2 views	25	25	$62.12	$34.46
76705 Limited ultrasound scan of abdomen	25	23	$145.00	$87.57
73030 X-ray of shoulder, minimum of 2 views	25	20	$55.00	$31.64
20610 Aspiration and/or injection of fluid from large joint	25	17	$95.00	$49.42
82044 Urine microalbumin (protein) analysis	24	24	$10.00	$6.19
72110 X-ray of lower and sacral spine, minimum of 4 views	22	22	$82.27	$46.14
82570 Creatinine level to test for kidney function or muscle injury	22	22	$15.00	$5.14
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	22	22	$167.73	$153.56
69210 Removal of impacted ear wax	22	21	$75.00	$43.03
11104 Punch biopsy, first skin growth	21	21	$185.00	$121.55
96360 Infusion into a vein for hydration, 31-60 minutes	20	16	$90.00	$30.86
73630 X-ray of foot, minimum of 3 views	20	20	$50.00	$31.25
17110 Destruction of up to 14 skin growths	18	13	$143.33	$103.42
73502 X-ray of hip, 2-3 views	18	17	$70.00	$43.03
70210 X-ray of paranasal sinus, 1-2 views	18	17	$57.00	$27.85
73110 X-ray of wrist, minimum of 3 views	17	15	$60.00	$36.76
99497 Advance care planning, first 30 minutes	16	16	$90.00	$85.15
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	15	14	$205.00	$136.87
20552 Injections of trigger points in 1 or 2 muscles	15	12	$100.00	$53.46
76882 Limited ultrasound scan of joint or other extremity structure except blood vessels	14	14	$100.00	$55.21
73610 X-ray of ankle, minimum of 3 views	14	14	$53.00	$33.22
73130 X-ray of hand, minimum of 3 views	14	14	$53.07	$33.22
72050 X-ray of upper spine, 4 or 5 views	13	12	$75.77	$48.08
90471 Administration of 1 vaccine	13	13	$35.00	$13.91
99495 Transitional care management services for problem of at least moderate complexity	12	12	$245.00	$181.57
90714 Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older	12	12	$30.00	$27.67
94640 Inhalation treatment for airway obstruction or sputum production	11	11	$35.00	$16.51
99406 Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes	11	11	$25.00	$15.11

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,356	683	$105.03	$70.68
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,276	555	$151.47	$103.88
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	829	557	$20.00	$8.34
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	515	113	$7.78	$1.58
J0696 Injection, ceftriaxone sodium, per 250 mg	358	60	$10.61	$0.55
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	290	290	$120.00	$111.76
99202 New patient office or other outpatient visit, typically 20 minutes	275	275	$110.00	$73.66
G0444 Annual depression screening, 5 to 15 minutes	268	268	$20.00	$17.24
71046 X-ray of chest, 2 views	216	188	$52.00	$29.26
36415 Insertion of needle into vein for collection of blood sample	205	137	$8.00	$2.90
81001 Manual urinalysis test with examination using microscope, automated	191	145	$10.00	$3.43
J1885 Injection, ketorolac tromethamine, per 15 mg	170	43	$3.00	$0.57
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	163	163	$150.86	$103.80
83036 Hemoglobin A1C level	146	95	$20.00	$10.14
G0008 Administration of influenza virus vaccine	137	135	$30.07	$15.78
90674 Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free	135	133	$29.54	$26.90
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	133	110	$71.95	$43.10
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	131	103	$34.96	$15.86
20611 Aspiration and/or injection of fluid large joint using ultrasound guidance	122	59	$140.00	$79.84
J1030 Injection, methylprednisolone acetate, 40 mg	100	48	$14.22	$6.19
87804 Detection test by immunoassay with direct visual observation for influenza virus	74	37	$29.19	$15.04
93000 Routine ekg using at least 12 leads including interpretation and report	69	62	$40.00	$15.86
69210 Removal of impacted ear wax	54	52	$75.00	$44.33
74019 X-ray of abdomen, 2 views	50	43	$62.00	$32.89
99406 Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes	46	37	$25.00	$14.50
96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less	46	41	$115.00	$65.58
73560 X-ray of knee, 1-2 views	45	43	$52.00	$30.88
94618 Test for exercise-induced lung stress	45	38	$60.00	$31.55
94010 Test to measure expiratory airflow and volume	43	41	$60.00	$33.38
82044 Urine microalbumin (protein) analysis	43	42	$10.00	$6.11
82570 Creatinine level to test for kidney function or muscle injury	43	42	$15.00	$5.63
J2405 Injection, ondansetron hydrochloride, per 1 mg	41	11	$0.62	$0.13
72110 X-ray of lower and sacral spine, minimum of 4 views	37	37	$82.00	$48.26
73130 X-ray of hand, minimum of 3 views	34	34	$52.00	$31.42
73030 X-ray of shoulder, minimum of 2 views	34	31	$55.00	$28.51
82962 Blood glucose (sugar) test performed by hand-held instrument	33	28	$10.00	$3.11
73630 X-ray of foot, minimum of 3 views	31	29	$50.00	$29.48
87880 Detection test by immunoassay with direct visual observation for streptococcus, group a (strep)	28	27	$25.00	$15.04
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	28	28	$166.43	$153.05
11104 Punch biopsy, first skin growth	27	25	$171.67	$113.97
73110 X-ray of wrist, minimum of 3 views	24	22	$60.00	$32.95
17110 Destruction of up to 14 skin growths	24	24	$141.25	$100.81
20610 Aspiration and/or injection of fluid from large joint	24	14	$95.00	$49.03
99497 Advance care planning, first 30 minutes	23	23	$90.00	$83.44
94640 Inhalation treatment for airway obstruction or sputum production	20	20	$35.00	$16.78
73502 X-ray of hip, 2-3 views	19	16	$70.00	$40.42
76882 Limited ultrasound scan of joint or other extremity structure except blood vessels	19	18	$100.00	$54.71
96360 Infusion into a vein for hydration, 31-60 minutes	18	16	$90.00	$35.67
10060 Simple or single drainage of skin abscess	18	18	$150.00	$105.79
17000 Destruction of skin growth	18	15	$90.56	$52.32
72050 X-ray of upper spine, 4 or 5 views	17	16	$75.00	$47.63
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	16	16	$205.00	$141.19
71100 X-ray of ribs of one side of body, 2 views	16	16	$61.00	$32.53
90471 Administration of 1 vaccine	15	15	$35.00	$14.89
70210 X-ray of paranasal sinus, 1-2 views	15	13	$57.00	$29.82
90714 Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older	15	15	$30.00	$21.95
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	14	14	$170.00	$164.72
20604 Aspiration and/or injection of fluid from small joint using ultrasound guidance	14	12	$115.00	$61.56
31231 Diagnostic examination of nasal passages using an endoscope	13	13	$275.00	$190.39
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$200.00	$160.09
10120 Removal of foreign body from tissue, accessed beneath the skin	12	12	$250.00	$145.91
99495 Transitional care management services for problem of at least moderate complexity	11	11	$245.00	$158.11
94060 Test to measure expiratory airflow and volume changes before and after medication administration	11	11	$100.00	$56.06

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,635	768	$105.01	$65.65
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	837	446	$146.82	$95.92
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	676	455	$20.00	$9.26
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	573	78	$2.79	$1.79
J0696 Injection, ceftriaxone sodium, per 250 mg	364	61	$9.00	$0.61
17003 Destruction of precancer skin growth, 2-14 growths	281	61	$17.86	$4.66
G0444 Annual depression screening, 5 to 15 minutes	275	275	$20.00	$16.07
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	273	273	$120.60	$105.35
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	251	251	$145.72	$99.30
99202 New patient office or other outpatient visit, typically 20 minutes	247	247	$109.92	$68.10
81001 Manual urinalysis test with examination using microscope, automated	190	140	$10.03	$3.84
71046 X-ray of chest, 2 views	178	152	$52.00	$27.16
G0008 Administration of influenza virus vaccine	151	149	$30.00	$19.20
36415 Insertion of needle into vein for collection of blood sample	124	83	$8.00	$2.94
83036 Hemoglobin A1C level	121	84	$20.93	$11.30
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	119	101	$72.14	$39.37
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	118	87	$35.00	$18.21
20611 Aspiration and/or injection of fluid large joint using ultrasound guidance	118	61	$134.19	$73.16
J1885 Injection, ketorolac tromethamine, per 15 mg	117	31	$3.00	$0.56
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	112	112	$28.00	$18.48
17000 Destruction of skin growth	96	80	$97.29	$48.53
17110 Destruction of up to 14 skin growths	94	86	$147.55	$96.75
87804 Detection test by immunoassay with direct visual observation for influenza virus	85	40	$29.65	$16.18
93000 Routine ekg using at least 12 leads including interpretation and report	69	67	$40.00	$14.86
J1030 Injection, methylprednisolone acetate, 40 mg	65	32	$8.12	$6.70
94010 Test to measure expiratory airflow and volume	55	52	$60.00	$31.92
94640 Inhalation treatment for airway obstruction or sputum production	45	41	$35.00	$16.37
74019 X-ray of abdomen, 2 views	44	40	$62.00	$29.57
96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less	43	39	$115.00	$64.05
69210 Removal of impacted ear wax	41	41	$75.00	$43.33
82962 Blood glucose (sugar) test performed by hand-held instrument	39	28	$10.00	$3.21
82570 Creatinine level to test for kidney function or muscle injury	38	37	$15.00	$6.26
82044 Urine microalbumin (protein) analysis	38	37	$10.00	$6.11
73630 X-ray of foot, minimum of 3 views	36	34	$50.00	$26.06
73560 X-ray of knee, 1-2 views	35	33	$53.49	$26.83
73030 X-ray of shoulder, minimum of 2 views	34	32	$55.00	$25.43
90674 Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free	33	33	$28.00	$23.57
99406 Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes	33	30	$25.00	$13.22
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	32	32	$170.00	$140.96
72110 X-ray of lower and sacral spine, minimum of 4 views	29	28	$82.00	$42.02
94618 Test for exercise-induced lung stress	29	23	$61.38	$31.22
17004 Destruction of precancer skin growth, 15 or more growths	25	22	$195.20	$134.30
87880 Detection test by immunoassay with direct visual observation for streptococcus, group a (strep)	25	23	$25.00	$15.55
72050 X-ray of upper spine, 4 or 5 views	24	24	$75.00	$40.28
81000 Manual urinalysis test with examination using microscope, non-automated	24	18	$10.00	$3.78
73610 X-ray of ankle, minimum of 3 views	23	22	$53.00	$27.94
20610 Aspiration and/or injection of fluid from large joint	20	17	$88.25	$54.26
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	20	17	$191.25	$132.66
11100 Biopsy of single growth of skin and/or tissue	19	19	$145.00	$85.61
94060 Test to measure expiratory airflow and volume changes before and after medication administration	19	18	$100.00	$53.79
73110 X-ray of wrist, minimum of 3 views	18	18	$60.00	$29.34
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	18	17	$65.00	$18.99
17111 Destruction of skin growth, 15 or more growths	17	16	$177.35	$121.78
73130 X-ray of hand, minimum of 3 views	16	15	$52.00	$28.23
31231 Diagnostic examination of nasal passages using an endoscope	15	15	$256.67	$186.68
71100 X-ray of ribs of one side of body, 2 views	15	14	$61.00	$29.57
96360 Infusion into a vein for hydration, 31-60 minutes	15	15	$90.00	$41.11
94664 Evaluation of use of breathing device	14	14	$25.00	$15.13
99496 Transitional care management services for problem of high complexity	14	14	$350.00	$210.61
99495 Transitional care management services for problem of at least moderate complexity	13	11	$245.00	$148.58
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	13	11	$110.00	$50.08
70210 X-ray of paranasal sinus, 1-2 views	13	13	$57.00	$24.43
10060 Simple or single drainage of skin abscess	13	13	$161.54	$99.62
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	13	13	$153.46	$92.04
81002 Urinalysis, manual test	12	12	$10.00	$3.13
73502 X-ray of hip, 2-3 views	11	11	$70.00	$36.59

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,063	509	$104.95	$65.60
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	536	299	$144.97	$96.01
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	425	303	$20.00	$9.89
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	348	58	$2.75	$1.79
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	217	217	$120.00	$106.16
99202 New patient office or other outpatient visit, typically 20 minutes	211	211	$109.88	$67.72
G0444 Annual depression screening, 5 to 15 minutes	194	194	$20.00	$16.36
J0696 Injection, ceftriaxone sodium, per 250 mg	184	34	$9.00	$0.62
36415 Insertion of needle into vein for collection of blood sample	159	126	$8.00	$2.83
81000 Manual urinalysis test with examination using microscope, non-automated	143	103	$10.00	$4.17
71020 X-ray of chest, 2 views, front and side	135	124	$52.00	$24.18
20611 Aspiration and/or injection of fluid large joint using ultrasound guidance	120	58	$125.75	$69.63
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	105	105	$143.05	$98.64
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	99	85	$72.00	$39.55
G0008 Administration of influenza virus vaccine	84	84	$30.00	$23.79
Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)	84	84	$28.00	$17.19
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	70	48	$35.00	$22.90
93000 Routine ekg using at least 12 leads including interpretation and report	55	52	$47.64	$15.33
J1885 Injection, ketorolac tromethamine, per 15 mg	37	13	$3.00	$0.58
G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)	36	36	$70.00	$58.33
69210 Removal of impacted ear wax	33	32	$75.00	$44.22
94010 Test to measure expiratory airflow and volume	32	31	$60.00	$31.29
87804 Detection test by immunoassay with direct visual observation for influenza virus	30	18	$29.00	$15.48
J1030 Injection, methylprednisolone acetate, 40 mg	29	16	$8.00	$5.65
73630 X-ray of foot, minimum of 3 views	28	27	$50.00	$26.33
87880 Detection test by immunoassay with direct visual observation for streptococcus, group a (strep)	28	26	$25.00	$16.11
96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less	27	25	$115.00	$62.03
74010 Imaging of abdomen	26	23	$62.92	$30.92
73560 X-ray of knee, 1-2 views	26	25	$51.23	$25.84
82962 Blood glucose (sugar) test performed by hand-held instrument	25	18	$10.00	$3.15
81002 Urinalysis, manual test	22	22	$10.00	$3.15
17000 Destruction of skin growth	21	17	$100.00	$56.94
83036 Hemoglobin A1C level	20	20	$21.00	$12.40
72110 X-ray of lower and sacral spine, minimum of 4 views	19	18	$83.89	$44.39
94640 Inhalation treatment for airway obstruction or sputum production	19	17	$35.00	$15.54
94060 Test to measure expiratory airflow and volume changes before and after medication administration	19	18	$100.00	$51.88
73130 X-ray of hand, minimum of 3 views	19	15	$52.00	$26.30
73030 X-ray of shoulder, minimum of 2 views	16	14	$55.00	$26.35
20610 Aspiration and/or injection of fluid from large joint	16	12	$85.00	$49.62
11100 Biopsy of single growth of skin and/or tissue	15	12	$133.00	$95.41
82570 Creatinine level to test for kidney function or muscle injury	15	15	$15.00	$6.24
82044 Urine microalbumin (protein) analysis	15	15	$10.67	$3.64
94620 Pulmonary exercise testing	15	13	$106.67	$51.65
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	14	14	$170.00	$148.28
17110 Destruction of up to 14 skin growths	13	11	$149.23	$100.95
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	12	12	$180.00	$124.37

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License MI 4301053321

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners

Heather Ferber , PA-C

Physician Assistant

NPI 1265689392

Physician Assistant (Certified)

Courtney Griffith-Sumpter , PHYSICIANS ASSISTANT

Physician Assistant - Medical

NPI 1346406592

PHYSICIANSASSISTANT

Tanya Drinkall

Nurse Practitioner

NPI 1538750831

Jessica Panoff , PA-C

Physician Assistant - Medical

NPI 1548639560

Physician Assistant (Certified)

Patricia Kelly , PA-C

Physician Assistant - Medical

NPI 1659438976

Physician Assistant (Certified)

Chelsea Navarro , PA-C

Physician Assistant

NPI 1740520980

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active June 10, 2011

NPI status registered as active in NPPES database

📍

Updated Practice Location June 10, 2011

Registered at 116 W MITCHELL ST, PETOSKEY, MI 497702324 (Tel: 2313482828)

📍

Updated Business Mailing Address June 10, 2011

Registered at 116 W MITCHELL ST, PETOSKEY, MI 497702324 (Tel: 2313482828)

👤

Provider Name / Credentials Updated June 10, 2011

Recorded as GUSTAV LO, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 10, 2011

General Practice (License #4301053321 in MI)

🟢

Initial NPI Registration & Enumeration January 04, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1568519635

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: January 04, 2007

Last Update: June 10, 2011

Sole Proprietor: No

Update or Correct Profile

Mailing Address

116 W Mitchell St

Petoskey, MI 497702324

Phone: 2313482828

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.