Individual provider Active NPI

Mark Dsouza, PA

  • Physician Assistant
  • Minnetonka, MN
National Provider Identifier
1902153125
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11170 Issued in MN
Practice address
10709 Wayzata Blvd Ste 200
Minnetonka, MN 55305-5509
Phone
(952) 888-5800
Fax
(952) 567-6156
NPI assigned
Aug 7, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 11170 MN Primary
Physician Assistant 363A00000X C04769 MD

Addresses

Primary practice location

10709 Wayzata Blvd Ste 200
Minnetonka, MN 55305-5509

Mailing address

9801 Dupont Ave S
Ste 425
Bloomington, MN 55431-3873
Phone (952) 888-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, 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
I20121226000317 MN Practitioner - Physician Assistant 3476706409 Reassigns benefits to 1 organization
I20140730000216 MD Practitioner - Physician Assistant 3476706409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minnesota Eye Consultants, PAGroup PAC ID 4284524539, 34 clinicians

Practice addresses (Care Compare)

9801 Dupont Ave S
Suite 200
Bloomington, MN 55431-3200
Phone (952) 888-5800

Merit-based Incentive Payment System (MIPS)

Final score
80.11 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
60.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C04769MDMDPhysician Assistant
11170MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Minnesota Eye Consultants, PA CurrentSince Mar 4, 2019 Accepting new patients
Johns Hopkins University CurrentSince Nov 24, 2014 Accepting new patients

Locations

4940 Eastern Ave
Baltimore, MD 21224

600 N Wolfe St
Baltimore, MD 21287

11091 Ulysses St NE
Ste 300
Blaine, MN 55434
Phone (763) 421-9410

9801 DuPont Ave S
Ste 200
Minneapolis, MN 55431

9801 DuPont Ave S
Ste 425
Minneapolis, MN 55431
Phone (952) 567-6092

10709 Wayzata Blvd
Ste 200
Minnetonka, MN 55305

7125 Tamarack Rd
Ste 100
Woodbury, MN 55125

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": "1344297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1902153125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S",
            "address_2": "STE 425",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313873",
            "telephone_number": "952-888-5800",
            "fax_number": "952-567-6176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10709 WAYZATA BLVD STE 200",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055509",
            "telephone_number": "952-888-5800",
            "fax_number": "952-567-6156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DSOUZA",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-07",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11170",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C04769",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

Verify at the official NPI Registry.