NPIMap

Individual provider Active NPI

Nicholas Carl Boetticher, M.D.

  • Gastroenterology Physician
  • Eagan, MN
National Provider Identifier
1295706620
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
46944 Issued in MN
Practice address
1185 Town Centre Dr
Eagan, MN 55123-1187
Phone
(612) 871-1145
Fax
(612) 870-5491
NPI assigned
Feb 1, 2006
Last updated
May 20, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 46944 MN Primary

Addresses

Primary practice location

1185 Town Centre Dr
Eagan, MN 55123-1187

Mailing address

PO Box 14909
Minneapolis, MN 55414-0909
Phone (612) 871-1145

Other identifiers 1

IdentifierTypeStateIssuer
906473700MedicaidMN

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
I20041004000342 MN Practitioner - GastroenterologyPractitioner - Internal Medicine 3476512773 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Texas Medical School at San Antonio, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mngi Digestive Health PAGroup PAC ID 8123016557, 276 clinicians

Practice addresses (Care Compare)

1185 Town Centre Dr
Suite 200
Eagan, MN 55123-1343
Phone (612) 871-1145

15700 37TH Ave N
Plymouth, MN 55446-3399
Phone (612) 871-1145

1575 Beam Ave
Maplewood, MN 55109-1126
Phone (651) 232-7000

201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (612) 892-2121

3001 Broadway St NE
Suite 500
Minneapolis, MN 55413-2197
Phone (612) 871-1145

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 520-5200

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

3588 Arcade St
Suite 110
Vadnais Heights, MN 55127-7135
Phone (612) 871-1145

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

800 E 28TH St
Minneapolis, MN 55407-3723
Phone (612) 863-4633

9145 Springbrook Dr NW
Suite 300
Coon Rapids, MN 55433-5897
Phone (612) 871-1145

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy34
Upper gastrointestinal (GI) endoscopy for acid reflux242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mngi Digestive Health, P.a. Gastroenterology CurrentSince Jul 20, 2010 Accepting new patients
Mayo Clinic Past Accepting new patients

Locations

1185 Town Centre Dr
Eagan, MN 55123
Phone 61243539602820

15700 37th Ave N
Plymouth, MN 55446
Phone (763) 577-0008

1185 Town Centre Dr
Ste 205
Saint Paul, MN 55123

3588 Arcade St
#110
Vadnais Heights, MN 55127

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: nicholas.boettichermd.p1@direct.mngastro.nextgenshare.com

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 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400544000000",
    "number": "1295706620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14909",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554140909",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 TOWN CENTRE DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231187",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETTICHER",
        "first_name": "NICHOLAS",
        "middle_name": "CARL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2014-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "46944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "906473700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.