Lisa Kotula, PMHNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Harrison Twp, Michigan. She graduated from nursing school in 2024 and has 1 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Pure Psychiatry Of Michigan Pllc, Downriver Mental Health Clinic Pc and 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
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 1639912298.
Provider's Profile
| Full Name | Lisa Kotula |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 1 Years |
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| Location | 25912 Ashby Dr, Harrison Twp, Michigan |
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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:
- Lisa Kotula graduated from nursing school in 2024
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 |
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| 1639912298 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 4704212792 (Michigan) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Pure Psychiatry Of Michigan Pllc | 1254741283 | 73 |
| Downriver Mental Health Clinic Pc | 7911995139 | 238 |
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 | Downriver Mental Health Clinic Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1295866135
PECOS PAC ID: 7911995139
Enrollment ID: O20040505000533 |
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| 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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| Entity Name | Healing Mental Health Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1497470975
PECOS PAC ID: 4789050188
Enrollment ID: O20221025003241 |
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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 |
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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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