Mrs Melissa Sue Brusacoram, APRN, CNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Chisholm, Minnesota. She graduated from nursing school in 2019 and has 5 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Northern Tranquility Mental Health Services and her current practice location is
118 W Lake St, Chisholm, Minnesota. You can reach out to her office (for appointments etc.) via phone at
(218) 254-0101.
Mrs Melissa Sue Brusacoram is licensed to practice in Minnesota (license number 7331) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1962051359.
Provider's Profile
| Full Name | Mrs Melissa Sue Brusacoram |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 5 Years |
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| Location | 118 W Lake St, Chisholm, Minnesota |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mrs Melissa Sue Brusacoram graduated from nursing school in 2019
NPI Data:
- NPI Number: 1962051359
- Provider Enumeration Date: 09/09/2019
- Last Update Date: 07/16/2021
Medicare PECOS Information:
- PECOS PAC ID: 1557686565
- Enrollment ID: I20200610002877
Medical Identifiers
Medical identifiers for Mrs Melissa Sue Brusacoram such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1962051359 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 163WP0808X | Registered Nurse - Psychiatric/mental Health | 2100555 (Minnesota) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 7331 (Minnesota) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Northern Tranquility Mental Health Services | 4981009479 | 5 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Melissa Sue Brusacoram allows following entities to bill medicare on her behalf.
| Entity Name | Northern Tranquility Mental Health Services |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1700469640
PECOS PAC ID: 4981009479
Enrollment ID: O20210820003039 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Melissa Sue Brusacoram is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mrs Melissa Sue Brusacoram, APRN, CNP
7478 Green Rock Rd,
Side Lake, MN 55781-8434
Ph: (218) 296-0688 | Mrs Melissa Sue Brusacoram, APRN, CNP
118 W Lake St,
Chisholm, MN 55719-1819
Ph: (218) 254-0101 |
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