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SHANE MICHAEL GUSTAFSON DO NPI 1922017623


NPI Information

NPI: 1922017623
Provider Name: SHANE MICHAEL GUSTAFSON, DO
Classification: Family Medicine - 207QS0010X
Entity Type: Individual

Specialization: Sports Medicine

PECOS Registration: Yes

Address:
8100 NORTHLAND DR
BLOOMINGTON, MN
ZIP 55431
Phone: (952) 831-8742
Get Directions

Shane Michael Gustafson, DO is a sports medicine family medicine in Bloomington, MN with 21 years of experience. The provider is 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. Shane Michael Gustafson, DO NPI is 1922017623. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: DES MOINES UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES
Graduation Year:2003

The provider's business location address is:

8100 NORTHLAND DR
BLOOMINGTON, MN
ZIP 55431-800
Phone: (952) 831-8742

The NPI 1922017623 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)
  • Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
  • Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance (HCPCS:20611)

The enumeration date for this NPI number is 8/5/2006 and was last updated on 6/17/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207QS0010XFamily MedicineSports Medicine50252MINNESOTAYes
2207QS0010XFamily MedicineSports Medicine34-008344OHIONo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1080016479OTHERMINNESOTAMEDICARE
2935408000MEDICAIDMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.