Laura Bergstrom, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

13671 Issued in MN

Practice address

8515 Eagle Point Blvd
Lake Elmo, MN 55042-8624

Phone

(612) 879-1000

NPI assigned

Sep 17, 2019

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 names 1

• Laura Wolter 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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Noran Neurological Clinic, P.a.Group PAC ID 3971497389, 54 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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 Care Compare group
• 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": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1770133175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 MINNESOTA DR STE 200",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355281",
            "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": "8515 EAGLE POINT BLVD",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550428624",
            "telephone_number": "612-879-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTROM",
        "first_name": "LAURA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "WOLTER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elisa Laura Bachmann
• Marcus Bachmann, PHD
• Matthew E Ballenthin, PSYD. LP
• Be Somebody Inc
• James R Benyon, CRNA
• Sarah Berkowitz
• Mariel J Blomstrand, MSW LICSW
• Blossom Towne Enterprises
• Carolyn Marie Bollinger, LICSW
• Mari Boyd, M.A., LMFT

• Physician Assistant in Lake Elmo, MN
• Providers in Lake Elmo, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; 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.