Shane Michael Gustafson, DO in Bloomington, MN

Shane Michael Gustafson, DO is a medicare enrolled "Family Medicine - Sports Medicine" physician in Bloomington, Minnesota. He went to Des Moines University Of Osteopathic Medicine And Health Sciences and graduated in 2003 and has 21 years of diverse experience with area of expertise as Sports Medicine. He is a member of the group practice Novacare Outpatient Rehabilitation East Inc, Park Nicollet Clinic and his current practice location is 8100 Northland Dr, Bloomington, Minnesota. You can reach out to his office (for appointments etc.) via phone at (952) 831-8742.

Shane Michael Gustafson is licensed to practice in Minnesota (license number 50252) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1922017623.

Contact Information

	Shane Michael Gustafson, DO
	8100 Northland Dr, Bloomington, MN 55431-4800
	(952) 831-8742
	Not Available

Map and Direction

Physician's Profile

Full Name	Shane Michael Gustafson
Gender	Male
Speciality	Sports Medicine
Experience	21 Years
Location	8100 Northland Dr, Bloomington, Minnesota
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Shane Michael Gustafson attended and graduated from Des Moines University Of Osteopathic Medicine And Health Sciences in 2003

NPI Data:

NPI Number: 1922017623
Provider Enumeration Date: 08/05/2006
Last Update Date: 06/17/2021

Medicare PECOS Information:

PECOS PAC ID: 1951305291
Enrollment ID: I20080108000093

Medical Identifiers

Medical identifiers for Shane Michael Gustafson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1922017623	NPI	-	NPPES
080016479	Other	MN	MEDICARE
935408000	Medicaid	MN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207QS0010X	Family Medicine - Sports Medicine	34-008344 (Ohio)	Secondary
207QS0010X	Family Medicine - Sports Medicine	50252 (Minnesota)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Park Nicollet Methodist Hospital	Saint louis park, MN	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Novacare Outpatient Rehabilitation East Inc	3678480290	666
Park Nicollet Clinic	7911819438	1530

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shane Michael Gustafson allows following entities to bill medicare on his behalf.

Entity Name	Park Nicollet Clinic
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1780621904 PECOS PAC ID: 7911819438 Enrollment ID: O20031104000046

Entity Name	Tria Orthopaedic Center Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1518273085 PECOS PAC ID: 3173570561 Enrollment ID: O20110310000999

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shane Michael Gustafson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Shane Michael Gustafson, DO 8170 33rd Ave S # Ms 21110q, Bloomington, MN 55425-4516 Ph: () -	Shane Michael Gustafson, DO 8100 Northland Dr, Bloomington, MN 55431-4800 Ph: (952) 831-8742

Reviews and Comments

Family Medicine Doctors in Bloomington, MN

Garrison Glenn Rice, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 8100 Northland Dr, Bloomington, MN 55431 Phone: 952-831-8742 Fax: 952-831-1626
Dr. Karen Lawson, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 8166 Utah Ave S, Bloomington, MN 55438 Phone: 612-369-0393
Dr. Samuel A.l. Bugbee, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 8100 Northland Dr, Bloomington, MN 55431 Phone: 952-831-8742 Fax: 952-831-1626
Christine Ann Morley, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 5320 Hyland Greens Dr, Bloomington, MN 55437 Phone: 952-993-2400
James K Struve, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 7901 Xerxes Ave S Ste 116, Bloomington, MN 55431 Phone: 952-888-2024 Fax: 952-888-3985
Mckayla Schmitt, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 8100 Northland Dr, Bloomington, MN 55431 Phone: 952-831-8742
John Alexander Noll, D.O Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 8100 Northland Dr, Bloomington, MN 55431 Phone: 952-831-8742

Shane Michael Gustafson, DO - Medicare Sports Medicine in Bloomington, MN