Melanie Waller, LICSW is a medicare enrolled "Social Worker - Clinical" provider in Edina, Minnesota. She graduated from healthcare school in 2019 and has 7 years of diverse experience with area of expertise as Clinical Social Worker. She is a member of the group practice Nystrom And Associates Ltd and her current practice location is
4600 77th St W Ste 370, Edina, Minnesota. You can reach out to her office (for appointments etc.) via phone at
(612) 464-1400.
Melanie Waller is licensed to practice in Minnesota (license number 24772) 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 1962098236.
Healthcare Provider's Profile
| Full Name | Melanie Waller |
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| Gender | Female |
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| Speciality | Clinical Social Worker |
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| Experience | 7 Years |
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| Location | 4600 77th St W Ste 370, Edina, 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:
- Melanie Waller graduated from medical school in 2019
NPI Data:
- NPI Number: 1962098236
- Provider Enumeration Date: 12/21/2020
- Last Update Date: 04/20/2026
Medicare PECOS Information:
- PECOS PAC ID: 0547769812
- Enrollment ID: I20250815000200
Medical Identifiers
Medical identifiers for Melanie Waller such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1962098236 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | (NU) | Secondary |
| 1041C0700X | Social Worker - Clinical | 24772 (Minnesota) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Nystrom And Associates Ltd | 6406752492 | 590 |
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. Melanie Waller allows following entities to bill medicare on her behalf.
| Entity Name | Nystrom & Associates Ltd |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1396750188
PECOS PAC ID: 6406752492
Enrollment ID: O20031210000592 |
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| Entity Name | Grow Healthcare Group PA |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1245845932
PECOS PAC ID: 3476961368
Enrollment ID: O20230310000874 |
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| Entity Name | Mosaic Therapy Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1679167126
PECOS PAC ID: 7810427986
Enrollment ID: O20250205002591 |
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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. Melanie Waller 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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Melanie Waller, LICSW
4600 77th St W Ste 370,
Edina, MN 55435-4912
Ph: (612) 464-1400 | Melanie Waller, LICSW
4600 77th St W Ste 370,
Edina, MN 55435-4912
Ph: (612) 464-1400 |
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