Brianne Elizabeth Gustafson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

13986 Issued in MN

Practice address

2200 NW 26TH St
Owatonna, MN 55060-5503

Phone

(507) 451-1120

NPI assigned

Mar 3, 2022

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

Electronic endpoints 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mayo Clinic Health System-Southeast Minnesota RegionGroup PAC ID 4385556703, 550 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bgustafson1709740@ehrdirect.mayoclinicmsg.org

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.

• Mayo Clinic Health System-Southeast Minnesota Region

  • Multi-Specialty Clinic/Center
  • Albert Lea, MN
  • NPI 1891701637
  Medicare reassignment Care Compare group
• Mayo Clinic Health System-Fairmont

  • Multi-Specialty Clinic/Center
  • Fairmont, MN
  • NPI 1366410862
  Medicare reassignment NPD
• Mayo Clinic Health System-Lake City

  • Multi-Specialty Clinic/Center
  • Lake City, MN
  • NPI 1164463659
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Mankato, MN
  • NPI 1578545422
  Medicare reassignment NPD (past)
• Mayo Clinic Health System-Southeast Minnesota Region

  • Multi-Specialty Clinic/Center
  • Owatonna, MN
  • NPI 1275060030
  NPD
• Mayo Clinic Health System-Southeast Minnesota Region

  • Clinic Pharmacy
  • Cannon Falls, MN
  • NPI 1699597468
  NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • New Prague, MN
  • NPI 1477089407
  NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Waseca, MN
  • NPI 1518494251
  NPD

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

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1912654567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 NW 26TH ST",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550605503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NW 26TH ST",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550605503",
            "telephone_number": "507-451-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "BRIANNE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-03",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bgustafson1709740@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "2200 NW 26th St",
            "city": "Owatonna",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550605503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amanda Susan Griswold, LICSW
• Allyssa Michelle Gronseth
• Krystal Marie Gross
• Ryan Guildner
• Avrahom Aharon Gurwitz, MD, MPH
• Patrick Michael Haberman, D.D.S.
• Michael Hafertepe, MD
• Sara Halla, L.A.D.C.
• Jill Hammitt, C.M.T., H.H.P.
• John Hansen, L.P.

• Physician Assistant in Owatonna, MN
• Providers in Owatonna, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; 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.