Active NPI
Jean M. Gustafson, MD
- Family Medicine Physician
- Bismarck, ND
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- RL11912
- Practice address
- 401 N 9TH St
Bismarck, ND 58501-4530 - Phone
- (701) 712-4500
- Fax
- (701) 712-4011
- NPI assigned
- Jun 28, 2011
- Last updated
- May 16, 2023
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | RL11912 | ND | Primary |
Addresses
Primary practice location
401 N 9TH St
Bismarck, ND 58501-4530
Mailing address
401 N 9TH St
Bismarck, ND 58501-4530
Phone (701) 712-4524
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12083 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of North Dakota School of Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
683 State Ave
Dickinson, ND 58601-4660
Phone (701) 483-9400
727 Kirkwood Mall
Bismarck, ND 58504-5753
Phone (701) 712-4500
Hospital & facility affiliations
- CHI Health at Home
- Essentia Health
- CHI St Alexius Health
- Sanford Medical Center Bismarck
- Garrison Memorial Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 22 |
| Removal or shaving of skin growth | 11 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RL11912 | ND | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovis Health LLC | Family Medicine | Current | Accepting new patients |
| Innovis Health, LLC | Current | Accepting new patients | |
| Mid Dakota Clinic, Inc. | Current | Accepting new patients | |
| Innovis Health LLC | Family Medicine | Current | Accepting new patients |
Locations
401 N 9th St
Bismarck, ND 58501
Phone (701) 530-6000
727 Kirkwood Mall
Bismarck, ND 58504
Phone (701) 530-5861
3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000
Organizations & group practices 5
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.
-
- Clinic/Center
- Bismarck, ND
- NPI 1275587826
-
dba Essentia Health-Osgood Clinic
- Multi-Specialty Clinic/Center
- Fargo, ND
- NPI 1144776576
Family Medicine
-
dba Essentia Health Hankinson Clinic
- Family Medicine Physician
- Hankinson, ND
- NPI 1750725743
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba CHI Health at Home
- Home Health Agency
- Bismarck, ND
- NPI 1255788949
-
- Critical Access Hospital
- Garrison, ND
- NPI 1982674560
-
dba CHI St. Alexius Health
- General Acute Care Hospital
- Bismarck, ND
- NPI 1306832654
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684195200000",
"number": "1437445442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 N 9TH ST",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585014530",
"telephone_number": "701-712-4524",
"fax_number": "701-712-4205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 N 9TH ST",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585014530",
"telephone_number": "701-712-4500",
"fax_number": "701-712-4011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "JEAN",
"middle_name": "M.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-28",
"last_updated": "2023-05-16",
"certification_date": "2023-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ND",
"license": "RL11912",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12083",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bismarck, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; 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.