Individual provider Active NPI

Wade Swoboda, PA-C

  • Physician Assistant
  • Woodbury, MN
National Provider Identifier
1578109765
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13393 Issued in MN
Practice address
2090 Woodwinds Dr Ste 200
Woodbury, MN 55125-2522
Phone
(651) 968-5201
Fax
(651) 767-1901
NPI assigned
Nov 21, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 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 13393 MN Primary

Addresses

Primary practice location

2090 Woodwinds Dr Ste 200
Woodbury, MN 55125-2522

Mailing address

710 Commerce Dr Ste 200
Woodbury, MN 55125-4925

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210225003384 MN Practitioner - Physician Assistant 6204241110 Reassigns benefits to 1 organization
I20230202001926 WI Practitioner - Physician Assistant 6204241110 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

2700 Vikings Cir
Eagan, MN 55121-1002
Phone (952) 456-7600

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

3545 Hwy 61 N
Vadnais Heights, MN 55110-5223
Phone (651) 439-8807

4040 Radio Dr
Woodbury, MN 55129-3237
Phone (651) 439-8807

5715 Memorial Ave N
Oak Park Heights, MN 55082-1093
Phone (651) 439-8807

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13393MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Nov 14, 2022 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Nov 14, 2022 Accepting new patients
Baldwin Area Medical Center Inc. CurrentSince Jan 1, 2023 Accepting new patients

Locations

2700 Vikings Cir
Eagan, MN 55121
Phone (952) 456-7600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

5715 Memorial Ave N
Stillwater, MN 55082
Phone (514) 398-8076

3545 Highway 61 N
Vadnais Heights, MN 55110

4040 Radio Dr
Woodbury, MN 55129
Phone (514) 398-8076

1100 Bergslien St
Baldwin, WI 54002
Phone (715) 684-1111

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1578109765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 COMMERCE DR STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 WOODWINDS DR STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252522",
            "telephone_number": "651-968-5201",
            "fax_number": "651-767-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWOBODA",
        "first_name": "WADE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-21",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.