MACKENZIE GUSTAFSON PMHNP
NPI 1669101234
Nurse Practitioner - Psychiatric/Mental Health in Twin Falls, ID
About Mackenzie Gustafson Pmhnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MACKENZIE GUSTAFSON PMHNP (NPI 1669101234) is an individual psychiatric/mental health provider in Twin Falls, Idaho, licensed in Idaho (59468) and active in the NPI registry since June 2022. She is enrolled in Medicare PECOS, is affiliated with St Lukes Magic Valley Medical Center, and is a graduate of Other (2022).
NPPES Registry Identity
Specialties & Licenses
Accepted 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
Mackenzie Gustafson Pmhnp 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.
Medicare Billing Reassignment
Medicare enrollment records show Mackenzie Gustafson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Twin Falls, ID 83301
- Reassigned Medicare billing, Idaho enrollment
- Medicare enrollment name: St Lukes Clinic LLC
- 322 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
St Lukes Magic Valley Medical Center
Acute Care Hospitals · Twin Falls, IDPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 83301 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 7
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
TWIN FALLS, ID 83301
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 Mackenzie Gustafson's NPI number?
The NPI number for Mackenzie Gustafson is 1669101234. It was assigned to this individual provider in the NPPES registry on June 8, 2022.
Where is Mackenzie Gustafson located?
Mackenzie Gustafson practices at 414 Shoup Ave W Ste B, Twin Falls, ID 83301. The listed phone number is (208) 814-9100.
What is Mackenzie Gustafson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Mackenzie Gustafson enrolled in Medicare?
Yes. Mackenzie 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 organization bills Medicare for Mackenzie Gustafson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mackenzie Gustafson reassigns Medicare benefits to St Luke's Clinic LLC (Twin Falls, ID). The 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 Mackenzie Gustafson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mackenzie Gustafson accept?
Health plans from PacificSource Health Plans, Providence Health Plan and Select Health list Mackenzie 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.
Is Mackenzie Gustafson affiliated with any hospitals?
According to CMS data, Mackenzie Gustafson is affiliated with St Lukes Magic Valley Medical Center.
When was this NPI record last updated?
The NPPES record for Mackenzie Gustafson was last updated on August 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Mackenzie Gustafson, PMHNP · NPI 1669101234
Psychiatric/Mental Health physician in Twin Falls, Idaho. Individual provider, active in the CMS NPPES registry since June 8, 2022.
## Identity
- **NPI:** 1669101234 (Entity type: Individual)
- **Enumerated:** June 8, 2022
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 59468 (Idaho)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 414 SHOUP AVE W STE B, Twin Falls, ID 83301-5042
- **Phone:** (208) 814-9100
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** St Luke's Clinic LLC (NPI 1790718229, Twin Falls, ID), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** August 19, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1669101234) · Data from the CMS NPPES public registry.