Active NPI
Amanda Boettger, PA-C
- Physician Assistant
- Maplewood, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 12596
- Practice address
- 1575 Beam Ave
Maplewood, MN 55109-1169 - Phone
- (651) 232-7348
- NPI assigned
- Jan 11, 2018
- Last updated
- Jun 15, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 12596 | MN | Primary |
| Physician Assistant | 363A00000X | 8981-23 | WI |
Addresses
Primary practice location
1575 Beam Ave
Maplewood, MN 55109-1169
Mailing address
2829 University Ave SE Ste 730
Minneapolis, MN 55414-3279
Other practice location 1
1925 Woodwinds Dr
Woodbury, MN 55125-4445
Phone (651) 232-0348
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: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1175 Nininger Rd
Hastings, MN 55033-1056
Phone (651) 404-1000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ecc Addiction & Toxicology Services LLC | Current | Accepting new patients |
Locations
2829 University Ave SE
Ste 730
Minneapolis, MN 55414
Phone (612) 439-1868
800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547
Interoperability endpoints
- aboettger793755@fairview.direct-ci.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.
-
- Emergency Medicine Physician
- Minneapolis, MN
- NPI 1669422788
-
- Medical Toxicology (Emergency Medicine) Physician
- Minneapolis, MN
- NPI 1629532429
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Fairview St John's Hospital
- General Acute Care Hospital
- Maplewood, MN
- NPI 1447218482
-
dba Fairview Woodwinds Hospital
- General Acute Care Hospital
- Woodbury, MN
- NPI 1356309322
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781481600000",
"number": "1548778665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2829 UNIVERSITY AVE SE STE 730",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554143279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 BEAM AVE",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551091169",
"telephone_number": "651-232-7348"
}
],
"practiceLocations": [
{
"address_1": "1925 Woodwinds Dr",
"address_purpose": "LOCATION",
"city": "Woodbury",
"state": "MN",
"postal_code": "551254445",
"country_code": "US",
"telephone_number": "651-232-0348",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOETTGER",
"first_name": "AMANDA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-11",
"last_updated": "2026-06-15",
"certification_date": "2026-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "12596",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "8981-23",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.