Shanshan Elissa Gustafson, is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Gaithersburg, Maryland. Her current practice location is
655 Watkins Mill Rd Fl 5, Gaithersburg, Maryland. You can reach out to her office (for appointments etc.) via phone at
(240) 632-4021.
Shanshan Elissa Gustafson is licensed to practice in * (Not Available) (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1417537259.
Physician's Profile
Full Name | Shanshan Elissa Gustafson |
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Gender | Female |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 655 Watkins Mill Rd Fl 5, Gaithersburg, Maryland |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1417537259
- Provider Enumeration Date: 04/14/2021
- Last Update Date: 07/10/2023
Medicare PECOS Information:
- PECOS PAC ID: 4486056074
- Enrollment ID: I20210702002720
Medical Identifiers
Medical identifiers for Shanshan Elissa Gustafson such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1417537259 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207R00000X | Internal Medicine | D0097815 (Maryland) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shanshan Elissa Gustafson allows following entities to bill medicare on her behalf.
Entity Name | Kaiser Foundation Health Plan Of The Mid-atlantic States,inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1952461816 PECOS PAC ID: 3779495858 Enrollment ID: O20040105000308 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shanshan Elissa Gustafson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Shanshan Elissa Gustafson, 655 Watkins Mill Rd Fl 5, Gaithersburg, MD 20879-3301 Ph: (240) 632-4021 | Shanshan Elissa Gustafson, 655 Watkins Mill Rd Fl 5, Gaithersburg, MD 20879-3301 Ph: (240) 632-4021 |
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