Individual provider Active NPI

Mackenzie Zimmerman, PA-C

  • Physician Assistant
  • Anoka, MN
National Provider Identifier
1205539889
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14428 Issued in MN
Practice address
2621 Greenhaven Road
Anoka, MN 55303
Phone
(763) 587-4400
NPI assigned
Mar 23, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14428 MN Primary

Addresses

Primary practice location

2621 Greenhaven Road
Anoka, MN 55303

Mailing address

2621 Greenhaven Rd
Anoka, MN 55303-5566
Phone (763) 587-4400

Other practice location 1

15245 Bluebird St NW
Andover, MN 55304-3538
Phone (952) 853-8800

Other practice location 2

530 3rd St NW
Elk River, MN 55330-1445
Phone (952) 853-8800

Other practice location 3

2621 Greenhaven Rd
Anoka, MN 55303-5566
Phone (952) 853-8800

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230518003586 MN Practitioner - Physician Assistant 1456717354 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

15245 Bluebird NWST
Andover, MN 55304-3554
Phone (763) 712-6000

2621 Greenhaven Rd
Anoka, MN 55303-1776
Phone (952) 853-8800

530 3Rd St NW
Elk River, MN 55330-1445
Phone (763) 712-6000

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Jun 5, 2023 Accepting new patients
Group Health, Inc. CurrentSince Jun 5, 2023 Accepting new patients
Group Health, Inc. Past Accepting new patients

Locations

15245 Bluebird St NW
Anoka, MN 55304
Phone (763) 587-4600

2621 Greenhaven Rd
Anoka, MN 55303
Phone (763) 587-4400

530 3rd St NW
Elk River, MN 55330
Phone (763) 587-4800

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1679529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764720000000",
    "number": "1205539889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 GREENHAVEN RD",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553035566",
            "telephone_number": "763-587-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 GREENHAVEN ROAD",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "55303",
            "telephone_number": "763-587-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15245 Bluebird St NW",
            "address_purpose": "LOCATION",
            "city": "Andover",
            "state": "MN",
            "postal_code": "553043538",
            "country_code": "US",
            "telephone_number": "952-853-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "530 3rd St NW",
            "address_purpose": "LOCATION",
            "city": "Elk River",
            "state": "MN",
            "postal_code": "553301445",
            "country_code": "US",
            "telephone_number": "952-853-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2621 Greenhaven Rd",
            "address_purpose": "LOCATION",
            "city": "Anoka",
            "state": "MN",
            "postal_code": "553035566",
            "country_code": "US",
            "telephone_number": "952-853-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "MACKENZIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-23",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anoka, MN

Sources for this page

Verify at the official NPI Registry.