Individual provider Active NPI

Marisa Mazza, PA-C

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1144817230
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4170 City Ave
Philadelphia, PA 19131-1610
Phone
(215) 262-7037
NPI assigned
Dec 23, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

4170 City Ave
Philadelphia, PA 19131-1610

Mailing address

4170 City Ave
Philadelphia, PA 19131-1610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220503000186 DC Practitioner - Physician Assistant 5698162535 Reassigns benefits to 1 organization
I20220512000602 MD Practitioner - Physician Assistant 5698162535 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

2000 Medical Pkwy
Suite 101
Annapolis, MD 21401-3743
Phone (410) 268-8862

2001 Medical Pkwy
Annapolis, MD 21401-3280
Phone (443) 481-1000

2003 Medical Pkwy
Annapolis, MD 21401-3081

2003 Medical Pkwy Wayson Pavillion
Advanced Internal Medicine Residenc
Annapolis, MD 21401-3081
Phone (443) 951-4286

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.45 of 100Reported as group
Quality
67.28
Promoting interoperability
98
Improvement activities
40
Cost
72.57

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC Single Specialty CurrentSince Aug 11, 2023 Accepting new patients
Orthopedic Physicians of Annapolis,LLC CurrentSince Apr 24, 2022 Accepting new patients
Luminis Health Medical Group, LLC Single Specialty CurrentSince Aug 11, 2023 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Aug 11, 2023 Accepting new patients
Luminis Health Medical Group, LLC Single Specialty Past Accepting new patients

Locations

2000 Medical Pkwy
Ste 101
Annapolis, MD 21401
Phone (410) 295-8900

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

2000 Medical Pkwy
Ste 409
Annapolis, MD 21401
Phone (443) 481-5136

201 Defense Hwy
Ste 150
Annapolis, MD 21401

4175 N Hanson Ct
Ste 201
Bowie, MD 20716
Phone (443) 481-1199

1630 Main St
Ste 213
Chester, MD 21619
Phone (443) 481-5300

1630 Main St
Ste 101
Chester, MD 21619
Phone (410) 604-6560

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1144817230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4170 CITY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 CITY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311610",
            "telephone_number": "215-262-7037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZA",
        "first_name": "MARISA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-23",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.