DR. MARK D. GUSTAFSON (MD) – Family Medicine Physician, NPI 1467439000
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,075 FAMILY PRACTICE in MN
Provider Addresses for DR. MARK D. GUSTAFSON (MD)
1601 Golf Course Rd
Grand Rapids, MN 557448648
Phone: (218) 326-5000
Type: Location
Essentia South University Clinic, 1702, South University Drive, Clara Barton, Fargo, Cass County, North Dakota, 58103, United States
FARGO, ND 581034940
Phone: (701) 364-4222
Type: Mailing
Essentia Health-Deer River, 115, 10th Avenue Northeast, Liston Evergreen Mobile Home Park, Deer River, Itasca County, Minnesota, 56636, United States
DEER RIVER, MN 566368795
Phone: (218) 246-8275
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-03-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100304001037 | I | Family Practice | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 142 | 37 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 15 | 14 | $0 |
Insurance plans in this area (ZIP 55744)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | MT | |
| - | ND | |
| Physician Assistant | MN | |
| Nurse Practitioner | SD | |
| - | MN | |
| Qualified Audiologist | MN | |
| - | MN | |
| - | MN | |
| P A T H O L O G Y | WV | |
| Family Practice | MN |
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