Mimi Song Idicula, NP is a medicare enrolled "Nurse Practitioner" provider in Irving, Texas. Her current practice location is
6161 N State Highway 161, Irving, Texas. You can reach out to her office (for appointments etc.) via phone at
(972) 258-7499.
Mimi Song Idicula is licensed to practice in Texas (license number AP137449) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1003009580.
Healthcare Provider's Profile
| Full Name | Mimi Song Idicula |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Location | 6161 N State Highway 161, Irving, Texas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1003009580
- Provider Enumeration Date: 08/20/2007
- Last Update Date: 07/13/2021
Medicare PECOS Information:
- PECOS PAC ID: 1052459120
- Enrollment ID: I20190628000060
Medical Identifiers
Medical identifiers for Mimi Song Idicula such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1003009580 | NPI | - | NPPES |
| AP137449 | Other | TX | NURSE PRACTITIONER |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111N00000X | Chiropractor | 10049 (Texas) | Secondary |
| 363L00000X | Nurse Practitioner | AP137449 (Texas) | Primary |
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. Mimi Song Idicula allows following entities to bill medicare on her behalf.
| Provider Name | Solar Health, P.a. |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1376724948
PECOS PAC ID: 3577625524
Enrollment ID: O20081229000479 |
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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. Mimi Song Idicula 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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Mimi Song Idicula, NP
6161 N State Highway 161,
Irving, TX 75038-2220
Ph: (972) 258-7499 | Mimi Song Idicula, NP
6161 N State Highway 161,
Irving, TX 75038-2220
Ph: (972) 258-7499 |
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