Lisa Kotula, PMHNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Harrison Twp, Michigan. Her current practice location is
25912 Ashby Dr, Harrison Twp, Michigan. You can reach out to her office (for appointments etc.) via phone at
(586) 242-6623.
Lisa Kotula is licensed to practice in Michigan (license number 4704212792) 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 1639912298.
Provider's Profile
Full Name | Lisa Kotula |
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Gender | Female |
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Speciality | Nurse Practitioner - Psychiatric/mental Health |
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Location | 25912 Ashby Dr, Harrison Twp, Michigan |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1639912298
- Provider Enumeration Date: 06/13/2024
- Last Update Date: 06/13/2024
Medicare PECOS Information:
- PECOS PAC ID: 0749717312
- Enrollment ID: I20241219004112
Medical Identifiers
Medical identifiers for Lisa Kotula such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1639912298 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 4704212792 (Michigan) | 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. Lisa Kotula allows following entities to bill medicare on her behalf.
Entity Name | Pure Psychiatry Of Michigan Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1831701671 PECOS PAC ID: 1254741283 Enrollment ID: O20201103002311 |
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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. Lisa Kotula 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 |
Lisa Kotula, PMHNP 25912 Ashby Dr, Harrison Twp, MI 48045-3081 Ph: (586) 242-6623 | Lisa Kotula, PMHNP 25912 Ashby Dr, Harrison Twp, MI 48045-3081 Ph: (586) 242-6623 |
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