Elizabeth N Boyum, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9778 Issued in MN

Practice address

14305 Southcross Dr W Ste 110
Burnsville, MN 55306-7011

Phone

(513) 401-0646

NPI assigned

Jun 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakes Dermatology PAGroup PAC ID 3375843089, 9 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

89.8 of 100Reported as group

Promoting interoperability

88

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: elizabeth.boyum@qdp.emadirect.md

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.

• Lakes Dermatology, PA

  • Dermatology Physician
  • Burnsville, MN
  • NPI 1962871608
  Medicare reassignment Care Compare group
• Pinnacle Dermatology, SC

  • Dermatology Physician
  • Plymouth, MN
  • NPI 1609009380
  Medicare reassignment
• Emergency Physicians & Consultants, PA

  • Emergency Medicine Physician
  • Waconia, MN
  • NPI 1194760009
  NPD (past)

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1750320487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14305 SOUTHCROSS DR W STE 110",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553067011",
            "telephone_number": "651-340-1064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14305 SOUTHCROSS DR W STE 110",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553067011",
            "telephone_number": "513-401-0646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYUM",
        "first_name": "ELIZABETH",
        "middle_name": "N",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1041654",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "507S6NE",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS HEALTH",
            "identifier": "HP36291",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Daly Borg, R.N.
• Cassidy Bos
• Elliott James Bosak
• Kelli Denk Bosholm, PT
• Kelley Boylan
• Bradshaw Psycholgical Services
• David R Bradshaw, MED, LP
• Emily Bradshaw
• Nancy L Bradshaw, RN, CNP
• Sharice Brady, DPT

• Physician Assistant in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; 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.

Verify at the official NPI Registry.