Alicia Gustafson, D.O.
Alicia Gustafson, D.O. is a Sports Medicine (Internal Medicine) Physician in Bloomington, MN, registered under NPI 1417210790. This provider registers 3 separate taxonomy codes, which usually means they practise across more than one recognised specialty.
Getting there
The practice address on file is 8100 NORTHLAND DR, Bloomington, MN 55431. We have not yet mapped what surrounds this office — parking, transit, and nearby pharmacies are added as our data collection reaches each location.
Credentials and Medicare
| Licence | State | Specialty |
|---|---|---|
| 75542 | MN | Sports Medicine (Internal Medicine)… primary |
| S9140 | TX | Family Medicine Physician |
| S9140 | TX | Sports Medicine (Family Medicine)… |
Licences are recorded in 2 states: MN, TX. Providers licensed in several states often practise near a state border or deliver telehealth across state lines.
- Status
- Approved
- Provider type
- Practitioner - Family Practice
- PAC ID
- 1951526730
Enrolled in Medicare 2 times, across 2 states:
| State | Enrollment ID | Provider type |
|---|---|---|
| Texas | I20210104002157 | Practitioner - Family Practice |
| Minnesota | I20240618001882 | Practitioner - Sports Medicine |
Medicare enrolment is recorded as approved under the provider type Practitioner - Family Practice. There are 2 separate enrolment records across 2 states (TX, MN). Multiple enrolments usually mean the provider bills Medicare from more than one practice location, or has kept an earlier enrolment after moving. Each record carries its own enrolment ID, listed above. Being enrolled means the provider can bill Medicare; it does not tell you whether they are currently accepting new Medicare patients. Call the office to confirm.
Licensed in 2 states
This provider holds licences in 2 states: Minnesota and Texas. The practice address on file is in Bloomington, MN, but a licence in another state usually means they see patients there too — either at a second location or by telehealth. If the address above is far from you, it is worth calling to ask whether they practise closer to where you live.
- Licence
- 75542
- Specialty
- Sports Medicine (Internal Medicine)…
Licence numbers are self-reported to NPPES at registration. They do not confirm a licence is currently active, in good standing, or valid for the specialty shown — only the state board can tell you that, which is why we link to each one.
What Sports Medicine covers
An internist trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the healthcare of the individual. NUCC Health Care Provider Taxonomy, code 207RS0010X
All registered taxonomy codes
This provider registers 3 taxonomy codes. The primary code is what appears on most claims; the others record additional recognised specialties.
| Code | Specialty | Licence | State | |
|---|---|---|---|---|
| 207RS0010X | Sports Medicine (Internal Medicine) Physician Sports Medicine | 75542 | MN | primary |
| 207Q00000X | Family Medicine Physician | S9140 | TX | |
| 207QS0010X | Sports Medicine (Family Medicine) Physician Sports Medicine | S9140 | TX |
The taxonomy records how the provider classifies their own practice. It does not confirm which conditions they currently treat, whether they are accepting new patients, or which insurance they take — call the office for that.
Full NPPES record
An NPI-1 identifies a single person. It stays with the clinician for life, even if they move practice or change state, which is why the address on file can lag behind where they actually work today.
| NPI | 1417210790 valid check digit |
|---|---|
| Entity type | Individual (NPI-1) |
| Enumeration date | Jun 21, 2012 |
| Last updated | May 10, 2024 |
| Status | Active |
| Sole proprietor | No |
| Credential | D.O. |
| Practice address |
8100 NORTHLAND DR Bloomington, MN 55431 (952) 831-8742 |
| Mailing address |
8170 33RD AVE S # MS 21110Q Bloomington, MN 55425 |
Number check
How the check works, step by step
Every NPI carries a Luhn check digit — the same scheme used on credit cards. CMS prefixes the number with 80840 before computing it, which marks it as a US health identifier.
| Digit | 8 | 0 | 8 | 4 | 0 | 1 | 4 | 1 | 7 | 2 | 1 | 0 | 7 | 9 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doubled? | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 |
| Value | 8 | 0 | 8 | 8 | 0 | 2 | 4 | 2 | 7 | 4 | 1 | 0 | 7 | 9 |
Sum = 60 · next multiple of 10 = 60 · check digit = 0 · actual last digit = 0
A valid check digit only means the number is well-formed. It does not mean the provider is licensed, active, or in good standing — those are separate questions answered by the sections above.