NPIMap

Individual provider Active NPI

Erica Bohlke Wagner, P.A.

  • Medical Physician Assistant
  • Eagan, MN
National Provider Identifier
1053810846
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
12588 Issued in MN
Practice address
3305 Central Park Village Dr Ste 200
Eagan, MN 55121-7707
Phone
(651) 406-8860
NPI assigned
Feb 7, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 12588 MN Primary

Addresses

Primary practice location

3305 Central Park Village Dr Ste 200
Eagan, MN 55121-7707

Mailing address

3305 Central Park Village Dr Ste 200
Eagan, MN 55121-7707
Phone (651) 406-8860

Other practice location 1

1158 Island Blvd
Welch, MN 55089-9540
Phone (651) 385-4148

Other names 1

  • Erica Marie Bohlke Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231108002955 MN Practitioner - Physician Assistant 4284081522 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

3305 Central Park Village Dr
Suite 200
Eagan, MN 55121-7707
Phone (651) 406-8860

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Nov 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Nov 1, 2023 Accepting new patients
Fairview Health Services CurrentSince Nov 1, 2023 Accepting new patients
Fairview Health Services CurrentSince Nov 1, 2023 Accepting new patients
Fairview Clinics CurrentSince Nov 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Nov 1, 2023 Accepting new patients
Piic Clinical Services PastSince Mar 24, 2025 Accepting new patients
Fairview Clinics Past Accepting new patients
Prairie Island Indian Community Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

3305 Central Park Village Dr
Ste 200
Saint Paul, MN 55121
Phone (651) 406-8860

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

Interoperability endpoints

  • Direct secure messaging: ewagner830372@fairview.direct-ci.com

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1053810846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 CENTRAL PARK VILLAGE DR STE 200",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551217707",
            "telephone_number": "651-406-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 CENTRAL PARK VILLAGE DR STE 200",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551217707",
            "telephone_number": "651-406-8860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1158 Island Blvd",
            "address_purpose": "LOCATION",
            "city": "Welch",
            "state": "MN",
            "postal_code": "550899540",
            "country_code": "US",
            "telephone_number": "651-385-4148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ERICA",
        "middle_name": "BOHLKE",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-07",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "12588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERICA",
            "last_name": "BOHLKE",
            "middle_name": "MARIE",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.