Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Simon Louis Mazza, PA-C, MSPAS

Individual provider Physician Assistant · NPI 1669043360

Simon Louis Mazza, PA-C, MSPAS is a Physician Assistant in Minneapolis, Minnesota. Qualified in 2021, 5 years ago. Practices with Twin Cities Physicians Professional Corporation, a 66-clinician group and accepts Medicare assignment.

Years since qualifying
5
In the registry since
2021
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1415 Lilac Dr N Ste 190
Minneapolis, MN 55422-4544
Phone: (763) 267-8701
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1669043360
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C , MSPAS
Sole proprietorNo
NPI enumeratedJuly 5, 2021
Last updated in NPPESJanuary 11, 2023
Certification dateJanuary 11, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Twin Cities Physicians Professional Corporation — 66 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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