NPIMap

Individual provider Active NPI

Katelyn Gustafson, PA-C

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1215636121
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2025044201 Issued in MO
Practice address
621 S New Ballas Rd Ste 560a
Saint Louis, MO 63141-8261
Phone
(314) 251-6440
Fax
(314) 251-4456
NPI assigned
Feb 28, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2025044201 MO Primary
Medical Physician Assistant 363AM0700X PA.0007815 CO

Addresses

Primary practice location

621 S New Ballas Rd Ste 560a
Saint Louis, MO 63141-8261

Mailing address

621 S New Ballas Rd Ste 560a
Saint Louis, MO 63141-8261
Phone (314) 251-6440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230403002615 CO Practitioner - Physician Assistant 1658746789 Reassigns benefits to 1 organization
I20251107003499 MO Practitioner - Physician Assistant 1658746789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Trauma and General Surgery LLCGroup PAC ID 1658320700, 44 clinicians

Practice addresses (Care Compare)

1259 Lake Plaza Dr
Suite 100
Colorado Springs, CO 80906-3542
Phone (719) 632-7669

4110 Briargate Pkwy
Suite 300
Colorado Springs, CO 80920-7837
Phone (719) 632-7669

621 S New Ballas Rd
Suite 560a
Saint Louis, MO 63141-8261
Phone (314) 569-6440

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2025044201MOMDPhysician Assistant
PA.0007815COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Trauma and General Surgery, LLC CurrentSince Oct 27, 2025 Accepting new patients
Colorado Springs Orthopaedic Group CurrentSince May 15, 2023 Accepting new patients
Pueblo Pathology Group, PC Current Accepting new patients
Colorado Springs Orthopaedic Group CurrentSince May 15, 2023 Accepting new patients

Locations

1259 Lake Plaza Dr
Ste 100
Colorado Springs, CO 80906
Phone (719) 867-7335

4110 Briargate Pkwy
Ste 300
Colorado Springs, CO 80920
Phone (719) 867-7329

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

621 S New Ballas Rd
Ste 560A
Saint Louis, MO 63141
Phone (314) 251-6440

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

Interoperability endpoints

  • Direct secure messaging: kgustafson@csog.emadirect.md

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.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762128000000",
    "number": "1215636121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 560A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418261",
            "telephone_number": "314-251-6440",
            "fax_number": "314-251-4456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 560A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418261",
            "telephone_number": "314-251-6440",
            "fax_number": "314-251-4456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "KATELYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-28",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2025044201",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0007815",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.