Eric Ross Boehm, PA-C
Individual provider Active NPI Physician Assistant · Delafield, WI
NPI 1497272215 · NPPES record last updated Sep 5, 2023
Key facts
- NPI
- 1497272215
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 4166-23 (WI)
- Practice address
- 2301 Sun Valley Dr
Delafield, WI 53018-2318 - Phone
- (262) 928-4043
- NPI assigned
- Aug 23, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Prohealth Medical Group Inc
Practice addresses (Care Compare)
1500 Walnut Ridge Dr
Hartland, WI 53029-9317
Phone (262) 928-7500
195 Discovery Dr
Brookfield, WI 53045-2862
Phone (262) 513-7100
2130 Big Bend Rd
Waukesha, WI 53189-7624
Phone (262) 928-7555
240 Maple Ave
Mukwonago, WI 53149-8475
Phone (262) 928-1900
N16W24131 Riverwood Dr
Waukesha, WI 53188-1106
Phone (262) 696-0808
N17W24100 Riverwood Dr
Waukesha, WI 53188-1127
Phone (262) 928-4704
Hospital & facility affiliations
- Waukesha Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171027002438 | WI | Practitioner - Physician Assistant | 9335415819 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4166-23 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Medical Group Inc. | Current |
Accepting new patients | |
| Prohealth Medical Group Inc | Current |
Accepting new patients | |
| Prohealth Medical Group Inc | Past | Accepting new patients |
Locations
195 Discovery Dr
Brookfield, WI 53045
Phone (262) 513-7100
2301 Sun Valley Dr
Delafield, WI 53018
Phone (262) 928-4043
1500 Walnut Ridge Dr
Hartland, WI 53029
Phone (262) 513-7500
5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089
2130 Big Bend Rd
Waukesha, WI 53189
Phone (262) 928-7555
N16W24131 Riverwood Dr
Waukesha, WI 53188
Phone (262) 696-0696
N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093
N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 4166-23 | WI | Yes |
Addresses
Primary practice location
2301 Sun Valley Dr
Delafield, WI 53018-2318
Mailing address
2301 Sun Valley Dr
Waukesha, WI 53018-2318
Phone (262) 928-4043
Other providers in Delafield, WI
- Jenifer Baum
- Kate Corinne Bennett
- Biomoto LLC
- Suzanne Blackwell
- Elizabeth Nicole Block
- Dayne Rae Borgh
- Maureen Brewster
- Ann Marie Brobson
- Emily Kay Brockway
- Bubon & Associates, Orthodontics, SC
All providers in Delafield, WI · Physician Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.