Mimily Harsono, MD in Memphis, TN

Mimily Harsono, MD is a medicare enrolled "Pediatrics - Neonatal-perinatal Medicine" physician in Memphis, Tennessee. Her current practice location is 877 Jefferson Ave, Memphis, Tennessee. You can reach out to her office (for appointments etc.) via phone at (901) 545-7100.

Mimily Harsono is licensed to practice in Tennessee (license number 50025) 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 1003137571.

Contact Information

	Mimily Harsono, MD
	877 Jefferson Ave, Memphis, TN 38103-2807
	(901) 545-7100
	Not Available

Map and Direction

Physician's Profile

Full Name	Mimily Harsono
Gender	Female
Speciality	Pediatrics - Neonatal-perinatal Medicine
Location	877 Jefferson Ave, Memphis, Tennessee
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1003137571
Provider Enumeration Date: 06/18/2010
Last Update Date: 02/25/2025

Medicare PECOS Information:

PECOS PAC ID: 5799925467
Enrollment ID: I20130701000816

Medical Identifiers

Medical identifiers for Mimily Harsono such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1003137571	NPI	-	NPPES
197560001	Medicaid	AR
177423	Medicaid	AL
1003137571	Medicaid	MI
02507295	Medicaid	MS
00179412A	Medicaid	GA
1003137571	Medicaid	MO
1532008	Medicaid	TN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
2080N0001X	Pediatrics - Neonatal-perinatal Medicine	50025 (Tennessee)	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. Mimily Harsono allows following entities to bill medicare on her behalf.

Entity Name	Ut Medical Group, Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1780676650 PECOS PAC ID: 3173435369 Enrollment ID: O20031105000384

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. Mimily Harsono 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
Mimily Harsono, MD 1068 Cresthaven Rd Ste 300, Memphis, TN 38119-0809 Ph: () -	Mimily Harsono, MD 877 Jefferson Ave, Memphis, TN 38103-2807 Ph: (901) 545-7100

Reviews and Comments

Pediatrics Doctors in Memphis, TN

Dr. Andrew Buchman Nearn, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 2861 Broad Ave, Memphis, TN 38112 Phone: 901-701-2520 Fax: 901-325-6469
Mr. Alberto S. Pappo, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 262 Danny Thomas Pl, Memphis, TN 38105 Phone: 901-595-6765 Fax: 901-521-9005
Edson Ruiz, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 877 Jefferson Ave, Memphis, TN 38103 Phone: 901-448-5950
Dr. Darlene K Cash, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 100 N Humphreys Blvd, Memphis, TN 38120 Phone: 901-322-9080 Fax: 901-322-2994
Dr. Monika Metzger, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 262 Danny Thomas Pl # Ms 515, C/o Dana Cannon, Memphis, TN 38105 Phone: 901-595-3006 Fax: 901-595-3842
Benjamin R Waller Iii, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 51 N Dunlap St Fl 2, Memphis, TN 38105 Phone: 901-287-7337 Fax: 901-287-4646

Mimily Harsono, MD - Medicare Pediatrics in Memphis, TN