ALICIA GUSTAFSON D.O.
NPI 1417210790
Internal Medicine - Sports Medicine in Bloomington, MN

Q: What is Alicia Gustafson's NPI number?

The NPI number for Alicia Gustafson is 1417210790. It was assigned to this individual provider in the NPPES registry on June 21, 2012.

Q: What is Alicia Gustafson's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Sports Medicine, with taxonomy code 207RS0010X.

Q: When was this NPI record last updated?

The NPPES record for Alicia Gustafson was last updated on May 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since June 21, 2012PECOS EnrolledAccepts Medicare Assignment

8100 NORTHLAND DR, BLOOMINGTON, MN 55431(952) 831-8742 Get Directions Write a Review

NPPES record last updated: May 10, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 10, 2024, Feb 23, 2022, Jan 4, 2021 and 4 more (7 updates tracked since 2016).

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About Alicia Gustafson D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALICIA GUSTAFSON D.O. (NPI 1417210790) is an individual sports medicine provider in Bloomington, Minnesota, licensed in Minnesota (75542) and active in the NPI registry since June 2012. She is enrolled in Medicare PECOS, maintains a secondary practice location in Justin, and is a graduate of Edward Via Col Of Osteo Medicine-virginia Campus (2012).

NPPES Registry Identity

NPI1417210790

Entity TypeIndividualFemale

Primary Taxonomy207RS0010X

Provider Legal NameALICIA GUSTAFSONCredential: D.O.

Location Address8100 NORTHLAND DRBloomington, MN 55431-4800

Mailing Address8170 33rd Ave S # Ms 21110qBloomington, MN 55425-4516

Phone(952) 831-8742

Sole ProprietorNo

Medical School CMSEdward Via Col Of Osteo Medicine-virginia CampusGraduated 2012

Enumeration DateJune 21, 2012

Last NPPES UpdateMay 10, 20247 updates tracked since enumeration

NPPES CertifiedMay 10, 2024

✔ NPI 1417210790 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal Medicine · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207RS0010X

License✔ Licensed in MN · 75542

Definition

An internist trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the healthcare of the individual.

Also ListedFamily MedicineTaxonomy 207Q00000X · License S9140 (TX)

Also ListedFamily Medicine · Sports MedicineTaxonomy 207QS0010X · License S9140 (TX)

8100 NORTHLAND DR, Bloomington, MN 55431

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Secondary Practice Location 1

Location 11976 Texan Dr., Suite 106Justin, TX 76247 · Phone (682) 212-9020

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Alicia Gustafson D.o. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1951526730

PECOS Enrollment IDI20240618001882

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Alicia Gustafson reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Tria Orthopaedic Center LLC

Same address

Orthopaedic Surgery

8100 NORTHLAND DR
Bloomington, MN 55431

Reassigned Medicare billing, Minnesota enrollment
693 clinicians in this Medicare group

NPI 1346624384 (952) 831-8742

Park Nicollet Methodist Hospital

5.2 mi

General Acute Care Hospital

3900 PARK NICOLLET BLVD
St Louis Park, MN 55416

Reassigned Medicare billing, Minnesota enrollment
Medicare enrollment name: Park Nicollet Clinic
2,527 clinicians in this Medicare group

NPI 1194113217 (952) 993-1953

Texas Health Physicians Group

846 mi

Internal Medicine

8440 WALNUT HILL LN STE 800
Dallas, TX 75231

Reassigned Medicare billing, Texas enrollment
1,639 clinicians in this Medicare group

NPI 1053767897 (214) 860-6300

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

71 services57 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

48 services41 patients

Injection, triamcinolone acetonide, not otherwise specified, 10 mg J3301

Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.

48 services13 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

33 services33 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

20 services20 patients

Aspiration and/or injection of fluid from large joint 20610

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

16 services13 patients

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NICOLE BREUER ATC

Specialist/Technologist (Athletic Trainer)

8100 NORTHLAND DR
BLOOMINGTON, MN 55431

Hennepin County (952) 831-8742

KIM M WATERBURY MS, OTRL, CHT

Occupational Therapist

8100 NORTHLAND DR
BLOOMINGTON, MN 55431

Hennepin County (952) 831-8742

JOSHUA VEENSTRA MD

Orthopaedic Surgery

8100 NORTHLAND DR
BLOOMINGTON, MN 55431

Hennepin County (952) 831-8742

MS. NANCY J CALLINAN OT

Occupational Therapist (Hand)

8100 NORTHLAND DR
BLOOMINGTON, MN 55431

Hennepin County (952) 831-8742

KELSEY GLEICH ATC

Specialist/Technologist (Athletic Trainer)

8100 NORTHLAND DR
BLOOMINGTON, MN 55431

Hennepin County (952) 831-8742

TRIA ORTHOPAEDIC CENTER LLC

Clinic/Center (Ambulatory Surgical)

8100 NORTHLAND DR
MINNEAPOLIS, MN 55431

Hennepin County (952) 831-8742

CHRISTOPHER M. WALKER ATC

Specialist/Technologist (Athletic Trainer)

8100 NORTHLAND DR
BLOOMINGTON, MN 55431

Hennepin County (952) 806-5745

GARRISON GLENN RICE DO

Family Medicine (Sports Medicine)

8100 NORTHLAND DR
BLOOMINGTON, MN 55431

Hennepin County (952) 831-8742

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 Alicia Gustafson's NPI number?

The NPI number for Alicia Gustafson is 1417210790. It was assigned to this individual provider in the NPPES registry on June 21, 2012.

Where is Alicia Gustafson located?

Alicia Gustafson practices at 8100 Northland Dr, Bloomington, MN 55431. The listed phone number is (952) 831-8742.

What is Alicia Gustafson's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Sports Medicine, with taxonomy code 207RS0010X.

Is Alicia Gustafson enrolled in Medicare?

Yes. Alicia Gustafson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Alicia Gustafson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Alicia Gustafson reassigns Medicare benefits to 3 organizations: Tria Orthopaedic Center LLC (Bloomington, MN), Park Nicollet Methodist Hospital (St Louis Park, MN) and Texas Health Physicians Group (Dallas, TX). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Alicia Gustafson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Alicia Gustafson accept?

Health plans from HealthPartners list Alicia Gustafson 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 Alicia Gustafson was last updated on May 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.