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NPI 1063958247ActiveOrganization· Preferred Provider Organization· Saint Paul, MN

Preferred Provider Organization in Saint Paul, Minnesota, registered in NPPES in January 2017. The authorized official on file is Judy Mae Gustafson, Owner.

Overview

NPI1063958247
StatusActive
Entity typeOrganization
NPI issuedJan 12, 2017
Last updated in NPPESJan 12, 2017

Specialties and licenses

TaxonomyCodeLicenseState
Preferred Provider Organization Primary305R00000X377579MN

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Nov 10, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 11, 2026No match—
New York OMIG · Nov 11, 2026No match—
Ohio Medicaid · Nov 11, 2026No match—
Pennsylvania Medicheck · Nov 11, 2026No match—
Washington HCA · Nov 11, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Not in the public enrollment file of Oct 1, 2026

Medicare sources and data years

Other Preferred Provider Organization providers in Saint Paul

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