NPIMap

Individual provider Active NPI

Amy Kay Bostic, PA-C

  • Physician Assistant
  • Plymouth, MN
National Provider Identifier
1467481994
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9942 Issued in MN
Practice address
15655 37TH Ave N Ste 100
Plymouth, MN 55446-4003
Phone
(763) 587-7900
Fax
(763) 587-7701
NPI assigned
Jun 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9942 MN Primary

Addresses

Primary practice location

15655 37TH Ave N Ste 100
Plymouth, MN 55446-4003

Mailing address

9201 W Broadway Ave Ste 601
Brooklyn Park, MN 55445-1924
Phone (763) 587-7900

Other identifiers 1

IdentifierTypeStateIssuer
751115900MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amy.bostic@nor.eclinicaldirectplus.com

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
I20081013000568 MN Practitioner - Physician Assistant 3476621772 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Clinic PAGroup PAC ID 2769384205, 50 clinicians

Practice addresses (Care Compare)

50 Central Ave
Osseo, MN 55369-1241
Phone (763) 587-7900

5109 36TH Ave N
Crystal, MN 55422-2007
Phone (763) 587-7900

9825 Hospital Dr
Suite 300
Maple Grove, MN 55369-4768
Phone (763) 587-7900

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Clinic, PA CurrentSince Oct 1, 2006 Accepting new patients

Locations

5109 36th Ave N
Minneapolis, MN 55422
Phone (630) 632-2648

9201 W Broadway Ave
Ste 601
Minneapolis, MN 55445
Phone (763) 587-7933

50 Central Ave
Osseo, MN 55369
Phone (612) 588-4625

15655 37th Ave N
Ste 100
Plymouth, MN 55446
Phone (612) 293-7822

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 and National Provider Directory roles.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1467481994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 W BROADWAY AVE STE 601",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554451924",
            "telephone_number": "763-587-7900",
            "fax_number": "763-587-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15655 37TH AVE N STE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554464003",
            "telephone_number": "763-587-7900",
            "fax_number": "763-587-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSTIC",
        "first_name": "AMY",
        "middle_name": "KAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "751115900",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amy.bostic@nor.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "15655 37th Ave N",
            "address_2": "Suite 100",
            "city": "Plymouth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "55446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.