Individual provider Active NPI

Erin Margaret-Campell Shields, DMFT

  • Marriage & Family Therapist
  • Eagan, MN
National Provider Identifier
1083170336
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
3528 Issued in MN
Practice address
2030 Rahn Way
Eagan, MN 55122-2300
Phone
(651) 529-1963
NPI assigned
Feb 12, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 3528 MN Primary

Addresses

Primary practice location

2030 Rahn Way
Eagan, MN 55122-2300

Mailing address

2030 Rahn Way
Eagan, MN 55122-2300
Phone (651) 529-1963

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240108004629 MN Practitioner - Marriage and Family Therapist 0648621219 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elizabeth Wagner PSYD LP IncGroup PAC ID 4183967219, 3 clinicians

Practice addresses (Care Compare)

4500 Park Glen Rd
Suite 450
Saint Louis Park, MN 55416-5190
Phone (951) 444-9744

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3526MNMDProfessional Counselor
3528MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Elizabeth Wagner, PSYD, LP, Inc. CurrentSince Dec 26, 2023 Accepting new patients
Fraser Past Accepting new patients
Fraser Child and Family Center PastSince Aug 23, 2023 Accepting new patients

Locations

4500 Park Glen Rd
Ste 450
St Louis Park, MN 55416
Phone (951) 444-9744

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1083170336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 RAHN WAY",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222300",
            "telephone_number": "651-529-1963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 RAHN WAY",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222300",
            "telephone_number": "651-529-1963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "ERIN",
        "middle_name": "MARGARET-CAMPELL",
        "name_prefix": "Dr.",
        "credential": "DMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-12",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.