Abigail R Boetticher, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

46169 Issued in MN

Practice address

2828 Chicago Ave South
Suite 200
Minneapolis, MN 55407-1320

Phone

(612) 879-1000

Fax

(612) 879-9116

NPI assigned

Feb 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Abigail R Bentch Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: abigailboetticher@direct.noranclinic.com
• FHIR API: https://fhir4.healow.com/fhir/r4/EFDABA

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.

• Noran Neurological Clinic P.a.

  • Specialist
  • Bloomington, MN
  • NPI 1710098306
  Medicare reassignment NPD
• Childrens Health Care

  • Pediatrics Physician
  • Minneapolis, MN
  • NPI 1932208808
  Medicare reassignment
• Minnesota Epilepsy Group PA

  • Neurology Physician
  • Roseville, MN
  • NPI 1932118056
  NPD (past)
• Quest Diagnostics LLC Il

  • Clinical Medical Laboratory
  • Chicago, IL
  • NPI 1669298055
  NPD (past)

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1730152034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 CHICAGO AVE SOUTH",
            "address_2": "SUITE 200",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071320",
            "telephone_number": "612-879-1000",
            "fax_number": "612-879-9116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 CHICAGO AVE SOUTH",
            "address_2": "SUITE 200",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071320",
            "telephone_number": "612-879-1000",
            "fax_number": "612-879-9116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETTICHER",
        "first_name": "ABIGAIL",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-08",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MN",
            "license": "46169",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "46169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "871425800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ABIGAIL",
            "last_name": "BENTCH",
            "middle_name": "R",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Leigh Boese, PHARMD
• Margaret L Boese, OTR/L
• Amber Joy Boesel, MA, LPC, ATR
• Eric Boeshart, MD
• Aerial Kristine Boettcher
• Joan Genevieve Boevers, LPCC
• Joanell A Boevers
• Kefale Teshome Bogale, RPH
• Melissa Ann Boggio, PNP-AC
• Leah Noelle Bohac-Stamps, M.A., CCC-A

• Neurology Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Neurology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.