Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Shane Michael Gustafson, DO

Individual provider Sports Medicine (Family Medicine) Physician · NPI 1922017623

Shane Michael Gustafson, DO practises Sports Medicine in Bloomington, Minnesota. Graduated from Des Moines University of Osteopathic Medicine and Health Sciences in 2003, 23 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota and Ohio.

Years since qualifying
23
Trained at
Des Moines University of Osteopathic Medicine and Health Sciences
Licensed in
MN, OH
In the registry since
2006
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

8100 Northland Dr
Bloomington, MN 55431-4800
Phone: (952) 831-8742
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1901 Connecticut Ave S, Sartell, MN 56377 — (320) 229-2118

Specialties & licences

Sports Medicine (Family Medicine) Physician (primary) Taxonomy 207QS0010X · Licence 50252 (MN)
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X · Licence 34-008344 (OH)

Record details

NPI number1922017623
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedAugust 5, 2006
Last updated in NPPESJune 17, 2021
Certification dateJune 17, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtySPORTS MEDICINE
Also practisesFAMILY PRACTICE
Medical schoolDES MOINES UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES
Graduated 2003 (23 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients365
Services billed 3,068 a service is one billed item, such as a visit, a test or a procedure
Average patient age73

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at Park Nicollet Clinic

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 1773 clinicians in the practice; 12 are shown here.

Other providers in Bloomington