MEDICARE: JASON M ERICKSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	46543	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00147329	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1041176	OTHER	PREFERRED ONE
2	HP42391	OTHER	HEALTH PARTNERS
3	2900346	OTHER	MEDICA HEALTH PLANS
4	506R1ER(PL)	OTHER	BLUE CROSS BLUE SHIELD
5	660954600	OTHER	MEDICAL ASSISTANCE
6	131474	OTHER	U-CARE
7	2157898	OTHER	ARAZ GROUP/AMERICAS PPO
8	386K6ER(RC)	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1992796676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON M ERICKSON MD

Provider Business Mailing Address
First Line	:	PO BOX 14909
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-0909
Country	:	US
Telephone Number	:	612-871-1145
Fax Number	:	612-870-5491

Provider Business Practice Location Address
First Line	:	5705 W OLD SHAKOPEE RD STE 150
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-3126
Country	:	US
Telephone Number	:	612-871-1145
Fax Number	:	612-870-5491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/07/2020

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