Individual provider Active NPI

Ivy L Erickson, PA-C

  • Physician Assistant
  • Onalaska, WI
National Provider Identifier
1205184025
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2923-23 Issued in WI
Practice address
191 Theater Rd
Onalaska, WI 54650
Phone
(608) 785-0940
NPI assigned
Aug 28, 2012
Last updated
Jan 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 002336 IA
Physician Assistant 363A00000X 2923-23 WI Primary

Addresses

Primary practice location

191 Theater Rd
Onalaska, WI 54650

Mailing address

PO Box 860912
Provider Enrollment - RST
Minneapolis, MN 55486-0912
Phone (507) 284-2511

Other practice location 1

800 West Ave S
LA Crosse, WI 54601-8806
Phone (608) 785-0940

Other practice location 2

800 West Ave S
LA Crosse, WI 54601-8806
Phone (608) 785-0940

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address iheims28026@ehrdirect.mayoclinicmsg.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160627000136 WI Practitioner - Physician Assistant 9537306543 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

191 Theater Rd
Onalaska, WI 54650-8679
Phone (608) 392-5000

800 E Blackhawk Ave
Prairie Du Chien, WI 53821-1698
Phone (608) 326-0808

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2923-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Jul 15, 2016 Accepting new patients

Locations

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

800 West Ave S
La Crosse, WI 54601
Phone (608) 372-5951

191 Theater Rd
Onalaska, WI 54650
Phone (608) 392-5000

705 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 357-2000

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

310 W Main St
Sparta, WI 54656
Phone (608) 269-1700

Interoperability endpoints

  • Direct secure messaging: iheims28026@ehrdirect.mayoclinicmsg.org

Organizations & group practices 2

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

Hospital & facility affiliations 1

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": "1346112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1205184025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860912",
            "address_2": "PROVIDER ENROLLMENT - RST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860912",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 THEATER RD",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "54650",
            "telephone_number": "608-785-0940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 West Ave S",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546018806",
            "country_code": "US",
            "telephone_number": "608-785-0940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 West Ave S",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546018806",
            "country_code": "US",
            "telephone_number": "608-785-0940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "IVY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-28",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "002336",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2923-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iheims28026@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "191 Theater Rd",
            "city": "Onalaska",
            "state": "WI",
            "country_code": "US",
            "postal_code": "54650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Onalaska, WI

Sources for this page

Verify at the official NPI Registry.