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

Simon Henry Lueth, PAC

Individual provider Physician Assistant · NPI 1215357108

Simon Henry Lueth, PAC is a Physician Assistant in Oak Park Heights, Minnesota. Qualified in 2014, 12 years ago. Practices with Fairview Express Care, a 1,964-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota and Wisconsin.

Years since qualifying
12
Licensed in
MN, WI
In the registry since
2014
Specialties on file
3
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

5803 Neal Ave N
Oak Park Heights, MN 55082-2177
Phone: (651) 439-8807
Fax: (651) 439-0232
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 640 Jackson St, Saint Paul, MN 55101-2502 — (651) 495-6600

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 11596 (MN)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 11596 (MN)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 3312-23 (WI)

Record details

NPI number1215357108
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedApril 18, 2014
Last updated in NPPESApril 20, 2026
Certification dateApril 20, 2026
Mailing address5803 Neal Ave N, Oak Park Heights, MN 55082-2177

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Fairview Express Care — 1964 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

Other providers in Oak Park Heights