Mr Mitchell John Fogal, PA-C - Medicare Physician Assistant in Waconia, MN

Mr Mitchell John Fogal, PA-C is a medicare enrolled "Physician Assistant" in Waconia, Minnesota. He graduated from nursing school in 2012 and has 12 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Shoreline Orthopaedic And Sports Medicine Clinic,plc and his current practice location is 560 S Maple St Ste 200, Suite 200, Waconia, Minnesota. You can reach out to his office (for appointments etc.) via phone at (952) 442-2163.

Mr Mitchell John Fogal is licensed to practice in Minnesota (license number 11173) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1407101538.

Contact Information

Mr Mitchell John Fogal, PA-C
560 S Maple St Ste 200, Suite 200,
Waconia, MN 55387-1757
(952) 442-2163
(952) 442-5903



Provider's Profile

Full NameMr Mitchell John Fogal
GenderMale
SpecialityPhysician Assistant
Experience12 Years
Location560 S Maple St Ste 200, Waconia, Minnesota
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Mr Mitchell John Fogal graduated from nursing school in 2012
  NPI Data:
  • NPI Number: 1407101538
  • Provider Enumeration Date: 07/15/2012
  • Last Update Date: 01/22/2013
  Medicare PECOS Information:
  • PECOS PAC ID: 2567613904
  • Enrollment ID: I20230727000529

Medical Identifiers

Medical identifiers for Mr Mitchell John Fogal such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1407101538NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant 11173 (Minnesota)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Holland Community HospitalHolland, MIHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Shoreline Orthopaedic And Sports Medicine Clinic,plc600289192620

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Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Mitchell John Fogal is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Mr Mitchell John Fogal, PA-C
4200 Dahlberg Dr Ste 300, Suite 300,
Golden Valley, MN 55422-4841

Ph: (952) 512-5637
Mr Mitchell John Fogal, PA-C
560 S Maple St Ste 200, Suite 200,
Waconia, MN 55387-1757

Ph: (952) 442-2163

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Physician Assistant Nurses in Waconia, MN

Laurie K. Grotzinger, PA
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 560 S Maple St, Suite 400, Waconia, MN 55387
Phone: 952-442-7804    
Nicole J Charles, PAC
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 500 S Maple St, Waconia, MN 55387
Phone: 952-442-2191    Fax: 952-974-3201
Sommer Nicole Vaughan, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 560 S Maple St, Suite 200, Waconia, MN 55387
Phone: 952-442-2163    Fax: 952-442-5903
Elizabeth Anne Radke, PA-C
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 500 S Maple St, Waconia, MN 55387
Phone: 952-442-2191    
Sarah Talbott, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 500 S Maple St, Waconia, MN 55387
Phone: 952-442-2191    
Morgan Malley, PA-C
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 560 S Maple St Ste 200, Waconia, MN 55387
Phone: 952-442-2163    
Jason Hicks, PA
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 500 S Maple St, Waconia, MN 55387
Phone: 952-442-2191    

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