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SHANE MICHAEL GUSTAFSON DO
NPI 1922017623
Family Medicine - Sports Medicine in Bloomington, MN

Active since August 05, 2006PECOS EnrolledAccepts Medicare Assignment
8100 NORTHLAND DR, BLOOMINGTON, MN 55431(952) 831-8742 Get Directions Write a Review

NPPES record last updated: June 17, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shane Michael Gustafson Do NPPES

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

SHANE MICHAEL GUSTAFSON DO (NPI 1922017623) is an individual sports medicine provider in Bloomington, Minnesota, licensed in Minnesota (50252) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS, is affiliated with Park Nicollet Methodist Hospital, and maintains a secondary practice location in Sartell.

NPPES Registry Identity

NPI1922017623
Entity TypeIndividualMale
Primary Taxonomy207QS0010X
Provider Legal NameSHANE MICHAEL GUSTAFSONCredential: DO
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 CMSDes Moines University Of Osteopathic Medicine And Health SciencesGraduated 2003
Enumeration DateAugust 5, 2006
Last NPPES UpdateJune 17, 2021
NPPES CertifiedJune 17, 2021
✔ NPI 1922017623 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
Licenses✔ Licensed in MN · 50252✔ Licensed in OH · 34-008344
Definition
A family medicine physician that is 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 health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
8100 NORTHLAND DR, Bloomington, MN 55431
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Secondary Practice Location 1

Location 11901 CONNECTICUT AVE SSARTELL, MN 56377 · Phone (320) 229-2118 · Fax (320) 259-8044

Other Identifiers 2

Other080016479MN · Medicare
Medicaid935408000MN

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shane Michael Gustafson Do 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 ID1951305291
PECOS Enrollment IDI20080108000093
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.

Areas of Expertise CMS Part B claims 9

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.

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.
1,024 services104 patients
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.
151 services131 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
114 services110 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.
91 services60 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.
70 services70 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.
70 services47 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Park Nicollet Methodist Hospital

Acute Care Hospitals · Saint Louis Park, MN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number240053
Location6500 Excelsior BlvdSaint Louis Park, MN 55426 · Hennepin County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55431 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$98.61 typical visit price
range $18.32 – $138.04
Typical copayment $24.65 (range $4.58 – $34.51)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Shane Gustafson's NPI number?

The NPI number for Shane Gustafson is 1922017623. It was assigned to this individual provider in the NPPES registry on August 5, 2006.

Where is Shane Gustafson located?

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

What is Shane Gustafson's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Is Shane Gustafson enrolled in Medicare?

Yes. Shane 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.

What insurance does Shane Gustafson accept?

Health plans from HealthPartners and Medica list Shane 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 Shane Gustafson affiliated with any hospitals?

According to CMS data, Shane Gustafson is affiliated with Park Nicollet Methodist Hospital.

When was this NPI record last updated?

The NPPES record for Shane Gustafson was last updated on June 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.