Active NPI
Mark Dsouza, PA
- Physician Assistant
- Minnetonka, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 11170
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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, MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
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
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 100
- 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.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C04769 | MD | MD | Physician Assistant |
| 11170 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minnesota Eye Consultants, PA | Current | Accepting new patients | |
| Johns Hopkins University | Current | 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.
-
- Ophthalmology Physician
- Bloomington, MN
- NPI 1508839879
-
- Pain Medicine (Anesthesiology) Physician
- Baltimore, MD
- NPI 1922008549
-
- Emergency Medicine Physician
- Baltimore, MD
- NPI 1386631810
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.