Susan Gustafson, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3594 Issued in MN

Practice address

219 SE Main St Ste 400
Minneapolis, MN 55414-2151

Phone

(612) 886-2524

Fax

(612) 886-2538

NPI assigned

Nov 15, 2006

Last updated

Aug 4, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Stone Arch Psychology and Health ServicesGroup PAC ID 6709045784, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stone Arch Psychology and Health Services

  • Clinical Psychologist
  • Minneapolis, MN
  • NPI 1124398607
  Medicare reassignment Care Compare group NPD Authorized official
• Associated Clinic of Psychology Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • St Louis Park, MN
  • NPI 1588741292
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501804800000",
    "number": "1073686655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 SE MAIN ST STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142151",
            "telephone_number": "612-886-2524",
            "fax_number": "612-886-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 SE MAIN ST STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142151",
            "telephone_number": "612-886-2524",
            "fax_number": "612-886-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "SUSAN",
        "credential": "LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2017-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025523800",
            "state": "FM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "6153482",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP49453",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "54P16GU",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimara Linell Gustafson, M.D., M.P.H
• Linda Rose Gustafson, PT
• Marisa Irene Gustafson, LICSW
• Mary Beth Gustafson, LICSW
• Sarah Krystine Gustafson
• Tamara Gustafson
• William Gustafson, PA-C
• Allison Marie Gustavson, DPT, PHD
• Rachel E Gustin, LMFT
• David Gregory Guth, DO

• Clinical Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.