SHANE MICHAEL GUSTAFSON (DO) – Sports Medicine (Family Medicine) Physician, NPI 1922017623
Sports Medicine (Family Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
243 SPORTS MEDICINE in MN
Provider Addresses for SHANE MICHAEL GUSTAFSON (DO)
1901 CONNECTICUT AVE S
SARTELL, MN 56377
Phone: (320) 229-2118
Fax: (320) 259-8044
Type: Location
Tria Orthopedic Center, 8100, Northland Drive, Bloomington, Hennepin County, Minnesota, 55435, United States
BLOOMINGTON, MN 554314800
Phone: (952) 831-8742
Type: Location
8170 33RD AVE S # MS 21110Q
BLOOMINGTON, MN 554254516
Phone:
Type: Mailing
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: 2008-01-08
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 |
|---|---|---|---|---|
| I20080108000093 | I | Sports Medicine | 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 |
|---|---|---|---|---|
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 820 | 92 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 104 | 87 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 72 | 55 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 69 | 68 | $0 |
| 20611 | Aspiration and/or injection of fluid large joint using ultrasound guidance | 57 | 40 | $0 |
Insurance plans in this area (ZIP 56377)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O B S T E T R I C S/ G Y N E C O L O G Y | MN | |
| Family Practice | MN | |
| - | MN | |
| Pulmonary Disease, Critical Care (Intensivists), Internal Medicine | MN | |
| Cardiac Electrophysiology | MN | |
| Family Practice | MN | |
| Physician Assistant | MN | |
| Physical Therapist In Private Practice | MN | |
| Physician Assistant | MN | |
| D E R M A T O L O G Y | MN |
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