Jacqueline M Gustafson, CPNP in Minneapolis, MN

Jacqueline M Gustafson, CPNP is a medicare enrolled "Nurse Practitioner - Pediatrics" in Minneapolis, Minnesota. Her current practice location is 2525 Chicago Ave S, Childrens Specialty Clinic Feeding Clinic Mpls, Minneapolis, Minnesota. You can reach out to her office (for appointments etc.) via phone at (651) 220-6446.

Jacqueline M Gustafson is licensed to practice in Minnesota (license number R1423754) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1760457527.

Contact Information

	Jacqueline M Gustafson, CPNP
	2525 Chicago Ave S, Childrens Specialty Clinic Feeding Clinic Mpls, Minneapolis, MN 55404
	(651) 220-6446
	(651) 220-6860

Map and Direction

Provider's Profile

Full Name	Jacqueline M Gustafson
Gender	Female
Speciality	Nurse Practitioner - Pediatrics
Location	2525 Chicago Ave S, Minneapolis, Minnesota
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1760457527
Provider Enumeration Date: 02/22/2006
Last Update Date: 08/10/2015

Medicare PECOS Information:

PECOS PAC ID: 1658385893
Enrollment ID: I20060126000960

Medical Identifiers

Medical identifiers for Jacqueline M Gustafson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1760457527	NPI	-	NPPES
928198300	Medicaid	MN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0200X	Nurse Practitioner - Pediatrics	R1423754 (Minnesota)	Primary

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. Jacqueline M Gustafson allows following entities to bill medicare on her 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

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. Jacqueline M 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
Jacqueline M Gustafson, CPNP 2910 Centre Pointe Dr, 35-121a Childrens Health Care, Roseville, MN 55113 Ph: (651) 855-2109	Jacqueline M Gustafson, CPNP 2525 Chicago Ave S, Childrens Specialty Clinic Feeding Clinic Mpls, Minneapolis, MN 55404 Ph: (651) 220-6446

Reviews and Comments

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Shiao-lin D Hui, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 920 2nd Ave S, Suite 400, Minneapolis, MN 55402 Phone: 612-659-7111 Fax: 612-659-7101
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Derek Przybylski, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2525 Chicago Ave, Minneapolis, MN 55404 Phone: 715-207-9330
Dr. Kenneth Mcrae, DNP, APRN, CNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2925 Chicago Ave, Minneapolis, MN 55407 Phone: 763-236-5000
Hannah L. Balfanz, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 814 South 3rd Street, Minneapolis, MN 55415 Phone: 612-888-9792

Jacqueline M Gustafson, CPNP - Medicare Nurse Practitioner in Minneapolis, MN