Kimara Linell Gustafson, M.D., M.P.H

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

53893 Issued in MN

Practice address

717 Delaware St SE Ste 353
Minneapolis, MN 55414-2959

Phone

(612) 624-1164

Fax

(612) 625-2920

NPI assigned

Apr 23, 2009

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

Medicare fee-for-service enrollment

Enrolled in MN, HI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Pediatric Medicine

Education

University of Minnesota Medical School, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgustafson328722@fairview.direct-ci.com

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.

• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment NPD
• Queens North Hawaii Community Hospital

  • Orthopaedic Surgery Physician
  • Kamuela, HI
  • NPI 1528049814
  Medicare reassignment NPD
• Fairview Express Care

  • Specialist
  • Wyoming, MN
  • NPI 1346587805
  NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD
• University of Minnesota Health Clinics and Surgery Center, Inc.

  • Clinic/Center
  • Minneapolis, MN
  • NPI 1053795187
  NPD
• University of Minnesota Physicians

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1477598118
  NPD
• Queens North Hawaii Community Hospital

  • Home Health Agency
  • Kamuela, HI
  • NPI 1124009584
  NPD
• Queens North Hawaii Community Hospital

  • General Acute Care Hospital
  • Kamuela, HI
  • NPI 1477559029
  NPD (past)

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1992949721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3304 22ND AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554075161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 DELAWARE ST SE STE 353",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142959",
            "telephone_number": "612-624-1164",
            "fax_number": "612-625-2920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "KIMARA",
        "middle_name": "LINELL",
        "credential": "M.D., M.P.H",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-23",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "53893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Gustafson
• Grant Joseph Gustafson
• Jacqueline M Gustafson, CPNP
• Janelle Marie Gustafson, CTRS
• Jeremy Gustafson, PHARM D
• Linda Rose Gustafson, PT
• Marisa Irene Gustafson, LICSW
• Mary Beth Gustafson, LICSW
• Sarah Krystine Gustafson
• Susan Gustafson, LP

• Pediatrics Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; 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.