NPIMap

Individual provider Active NPI

William Gustafson, PA-C

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1295137206
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2916 42ND Ave S
Minneapolis, MN 55406-1820
Phone
(541) 602-1340
NPI assigned
Sep 22, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2916 42ND Ave S
Minneapolis, MN 55406-1820

Mailing address

2916 42ND Ave S
Minneapolis, MN 55406-1820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, TX, OH, WI4 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 4

Enrollment IDStateProvider typePAC IDDetails
I20150324000631 MN Practitioner - Physician Assistant 4284951674
I20191217000843 TX Practitioner - Physician Assistant 4284951674 Reassigns benefits to 1 organization
I20220330000513 OH Practitioner - Physician Assistant 4284951674 Reassigns benefits to 1 organization
I20250305003564 WI Practitioner - Physician Assistant 4284951674 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upland Hills Health IncGroup PAC ID 3072415553, shared by 13 NPIs, 97 clinicians

Practice addresses (Care Compare)

1883 Springdale St
Mount Horeb, WI 53572-2477
Phone (608) 437-8040

551 Main St
Highland, WI 53543-9779
Phone (608) 929-4518

Hospital & facility affiliations

  • Columbus Community Hospital Hospital, Columbus, WI, CCN 521338
  • SSM Health St Mary'S Hospital - Madison Hospital, Madison, WI, CCN 520083
  • SSM Health St Clare Hospital - Baraboo Hospital, Baraboo, WI, CCN 520057

Merit-based Incentive Payment System (MIPS)

Final score
96.9 of 100Reported as group
Quality
91.17
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Upland Hills Health, Inc CurrentSince Jan 1, 2025 Accepting new patients
Upland Hills Health, Inc. CurrentSince Dec 1, 2025 Accepting new patients
Upland Hills Health, Inc. CurrentSince Jan 1, 2025 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Oct 28, 2019 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Oct 28, 2019 Accepting new patients
Prairie Ridge Health Inc. CurrentSince Nov 1, 2025 Accepting new patients
Prairie Ridge Health, Inc. CurrentSince Nov 1, 2025 Accepting new patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Upland Hills Health, Inc. Past Accepting new patients
Prairie Ridge Health, Inc. Past Accepting new patients

Locations

1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200

1511 Park Ave
Columbus, WI 53925
Phone (920) 623-3012

800 Compassion Way
Dodgeville, WI 53533
Phone (608) 930-7200

1809 Springdale St
Mount Horeb, WI 53572
Phone (608) 437-8033

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/a87187e5-fe2f-447e-bf32-4eeb3954a735/

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1295137206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2916 42ND AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554061820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2916 42ND AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554061820",
            "telephone_number": "541-602-1340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "WILLIAM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-22",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.