Doctor profile · Federal record
Dr. Alicia Gustafson, D.O.
Sports Medicine (Internal Medicine) Physician (CMS: Sports Medicine) · Family Medicine Physician · Sports Medicine (Family Medicine) Physician · Bloomington, MN
- NPI 1417210790
- Accepts Medicare
- 14 yrs in practice
- Licensed in 2 states
- Female
- Group practice
- No sanctions
Practice & contact
Operates at 2 locations .
- Primary practice
-
8100 Northland Dr
Bloomington, MN 554314800
(952) 831-8742 - Additional location
-
1976 Texan Dr., Suite 106
Justin, TX 76247
(682) 212-9020 - Mailing address
-
8170 33Rd Ave S # MS 21110Q
Bloomington, MN 554254516
Credentials & registration
- NPI registered
- June 2012 — 14 yrs on file
- Profile last updated
- May 10, 2024
- Year of graduation
- 2012 — 14 yrs since
- Specialty taxonomy
- 207RS0010X — NUCC code
- State licenses (2)
- Minnesota #75542 · Texas #S9140
Federal sanctions & exclusions
No sanctions, exclusions or revocations on file
Checked against OIG LEIE on NPI 1417210790. Last verified May 11, 2026.Medicare procedures · 2023
Top services delivered
Total services
171
Distinct HCPCS
5
Medicare allowed
$18,813
| HCPCS | Description | Services | Patients | Avg allowed | |
|---|---|---|---|---|---|
99214 |
Established patient office or other outpatient visit, 30-39 minutes | 75 | 39 | $116 | |
99213 |
Established patient office or other outpatient visit, 20-29 minutes | 50 | 31 | $84 | |
99204 |
New patient office or other outpatient visit, 45-59 minutes | 16 | 16 | $152 | |
99203 |
New patient office or other outpatient visit, 30-44 minutes | 15 | 15 | $107 | |
G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 15 | 15 | $124 |
In context: peer comparison
Among 1 peers in this city , average services per provider: 34. This provider delivers 5.0× the peer median.Medicare Part D · 2023
Top prescriptions
Total claims
758
Patients
229
Total drug cost
$49,114
| Drug | Type | Claims | Patients | Total cost |
|---|---|---|---|---|
| Lisinopril | Generic | 99 | 36 | $965 |
| Atorvastatin Calcium | Generic | 88 | 31 | $1,418 |
| Metformin Hcl | Generic | 66 | 21 | $748 |
| Levothyroxine Sodium | Generic | 64 | 26 | $1,106 |
| Azelastine Hcl | Generic | 61 | 31 | $2,089 |
| Gabapentin | Generic | 57 | 21 | $1,871 |
| Amlodipine Besylate | Generic | 51 | 19 | $608 |
| Losartan Potassium | Generic | 45 | 16 | $678 |
| Simvastatin | Generic | 41 | 0 | $258 |
| Hydrochlorothiazide | Generic | 36 | 0 | $226 |
Frequently asked questions
What is Dr. Alicia Gustafson's medical specialty?
Dr. Alicia Gustafson practices Sports Medicine (Internal Medicine) Physician in Bloomington, MN.
Where does Dr. Alicia Gustafson practice?
Dr. Alicia Gustafson practices at 8100 Northland Dr, Bloomington, MN 554314800. Office phone: 9528318742.
What is Dr. Alicia Gustafson's NPI?
Dr. Alicia Gustafson's National Provider Identifier (NPI) is 1417210790, issued by NPPES.
Does Dr. Alicia Gustafson accept Medicare assignment?
Yes. Dr. Alicia Gustafson accepts Medicare assignment, meaning Medicare-allowed amounts are accepted as full payment for covered services.
What procedures does Dr. Alicia Gustafson commonly perform?
Top Medicare-reported procedures in 2023: Established patient office or other outpatient visit (HCPCS 99214); Established patient office or other outpatient visit (HCPCS 99213); New patient office or other outpatient visit (HCPCS 99204). Source: CMS Medicare Physician & Other Practitioners file.