Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Avery Grace Macintosh

Individual provider Physician Assistant · NPI 1609633510

Avery Grace Macintosh is a Physician Assistant in Mahtomedi, Minnesota. Qualified in 2025, 1 year ago. Practices with Dermatology Associates of Siouxland PC, a 3-clinician group and accepts Medicare assignment.

Years since qualifying
1
In the registry since
2024

Practice location Address checks out

1040 Summit Ave
Mahtomedi, MN 55115-1544
Phone: (651) 815-3171
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1609633510
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 6, 2024
Last updated in NPPESMarch 6, 2024
Certification dateMarch 6, 2024
Mailing address1040 Summit Ave, Mahtomedi, MN 55115-1544

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Dermatology Associates Of Siouxland Pc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Mahtomedi