Terry Boksberger, D.O.
Individual provider Active NPI Family Medicine Physician · Wayzata, MN
NPI 1689867129 · NPPES record last updated Feb 25, 2016
Key facts
- NPI
- 1689867129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 107105 (MN)
- Practice address
- 250 Central Ave N
Suite 228
Wayzata, MN 55391-1206 - Phone
- (952) 993-8250
- Fax
- (952) 993-8276
- NPI assigned
- Aug 18, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Park Nicollet Clinic
Practice addresses (Care Compare)
15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440
250 Central Ave N
Wayzata, MN 55391-1206
Phone (952) 993-3123
300 Lake Dr E
Chanhassen, MN 55317-9302
Phone (952) 993-4300
3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123
3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123
5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400
Hospital & facility affiliations
- Park Nicollet Methodist Hospital Care SVCS
- Park Nicollet Methodist Hospital
- Park Nicollet Methodist Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131115000683 | MN | Practitioner - Family Practice | 1557412046 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101016814 | MI | MD | Family Medicine Physician |
| 107105 | MN | MD | Family Medicine Physician |
| 2011-00868 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Clinic | Family Medicine | Current |
Accepting new patients |
| Park Nicollet Clinic | Family Medicine | Current | Accepting new patients |
| Park Nicollet Clinic | Past | Accepting new patients |
Locations
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
250 Central Ave N
Ste 220
Wayzata, MN 55391
Phone (952) 993-8250
250 Central Ave N
Ste 228
Wayzata, MN 55391
Phone (952) 993-8250
250 Central Ave N
Ste 103
Wayzata, MN 55391
Phone (952) 249-2000
Interoperability endpoints
- tboksberger153652@direct.healthpartners.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101016814 | MI | |
| Family Medicine Physician | 207Q00000X | 107105 | MN | Yes |
| Family Medicine Physician | 207Q00000X | 2011-00868 | NC |
Addresses
Primary practice location
250 Central Ave N
Suite 228
Wayzata, MN 55391-1206
Mailing address
8170 33Rd Ave S
PO Box 1309 Mail Stop 21110Q
Minneapolis, MN 55425-4516
Phone (952) 993-8250
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5919235 | Medicaid | NC |
Other providers in Wayzata, MN
- Troy Wendell Bjorklund
- Nancy Duffey Black
- Abbey Blair
- Jerome Thomas Blaschke
- Mariah Lynn Bokman
- Rose Ellen Shultz Boyd
- Brewer Corp PA
- Mark Eugene Brewer
- Brian V. Nelson, LP
- Barbro Brost
All providers in Wayzata, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2016. 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.