Active NPI
Maxine Rae Gustafson, PA-C
- Physician Assistant
- Edina, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 12582
- Practice address
- 6525 France Ave S Ste 200
Edina, MN 55435-2176 - Phone
- (952) 927-6501
- Fax
- (952) 653-1433
- NPI assigned
- Nov 9, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 12582 | MN | Primary |
Addresses
Primary practice location
6525 France Ave S Ste 200
Edina, MN 55435-2176
Mailing address
6525 France Ave S Ste 200
Edina, MN 55435-2176
Phone (952) 927-6501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1185 Town Centre Dr
Eagan, MN 55123-1189
Phone (651) 999-6800
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000
6025 Lake Rd
Suite 200
Woodbury, MN 55125-1710
Phone (651) 999-6800
7500 France Ave S
Edina, MN 55435-3400
Phone (952) 927-6501
800 E 28TH St
Minneapolis, MN 55407-3723
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.84 of 100
- Quality
- 64.59
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 84.88
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.6 of 100
- Quality
- 72.5
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.07
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12582 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients |
Locations
2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
7500 France Ave S
Minneapolis, MN 55435
Phone (952) 835-1311
2855 Campus Dr
Ste 650
Plymouth, MN 55441
Phone (763) 270-3400
2855 Campus Dr
Ste 530
Plymouth, MN 55441
Phone (763) 383-8870
360 Sherman St
Ste 450
Saint Paul, MN 55102
Phone (651) 641-7100
Interoperability endpoints
- clinical@ualtd.directbygreenway.com
- maxine.gustafson.1@20581.direct.athenahealth.com
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
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- Buffalo, MN
- NPI 1295272342
-
- Urology Physician
- Woodbury, MN
- NPI 1912971912
-
- Addiction (Substance Use Disorder) Psychologist
- Fridley, MN
- NPI 1083197214
-
- Rheumatology Physician
- Coon Rapids, MN
- NPI 1952146516
Hospital & facility affiliations 26
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510185600000",
"number": "1083127203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6525 FRANCE AVE S STE 200",
"city": "EDINA",
"state": "MN",
"postal_code": "554352176",
"telephone_number": "952-927-6501",
"fax_number": "952-653-1433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6525 FRANCE AVE S STE 200",
"city": "EDINA",
"state": "MN",
"postal_code": "554352176",
"telephone_number": "952-927-6501",
"fax_number": "952-653-1433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "MAXINE",
"middle_name": "RAE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-09",
"last_updated": "2017-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "12582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.