Mimi Song Idicula, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP137449 Issued in TX

Practice address

6161 N State Highway 161
Irving, TX 75038-2220

Phone

(972) 258-7499

Fax

(972) 257-0897

NPI assigned

Aug 20, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IDCGBD
• FHIR API: https://fhir4.healow.com/fhir/r4/IDCGBD/Endpoint/IDCGBD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Solar Health, P.a.

  • Interventional Pain Medicine Physician
  • Farmers Branch, TX
  • NPI 1376724948
  Medicare reassignment NPD
• Solar Health, P.a.

  • Interventional Pain Medicine Physician
  • Rockwall, TX
  • NPI 1861966327
  NPD
• Cynergy Chiropractic Center PA

  • Chiropractor
  • McKinney, TX
  • NPI 1851541700
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1003009580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6161 N STATE HIGHWAY 161",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750382220",
            "telephone_number": "972-258-7499",
            "fax_number": "972-257-0897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6161 N STATE HIGHWAY 161",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750382220",
            "telephone_number": "972-258-7499",
            "fax_number": "972-257-0897"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1717 W University Dr",
            "address_2": "#408",
            "address_purpose": "LOCATION",
            "city": "McKinney",
            "state": "TX",
            "postal_code": "75069",
            "country_code": "US",
            "telephone_number": "972-548-2600",
            "fax_number": "972-548-2610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IDICULA",
        "first_name": "MIMI",
        "middle_name": "SONG",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-20",
        "last_updated": "2021-07-13",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "10049",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP137449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER",
            "identifier": "AP137449",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Iconiq Spine & Orthopaedic Center PLLC
• Ideal Chiropractic
• Ideal Dental of Irving PLLC
• Ideal Smiles of Irving PLLC
• Idh Medical Practice, P.a.
• Lawrence Idigbe
• Sarah Idris, RD
• Ayah Ifteiha, LPA
• Mary Anne Igboagi
• Ighoking International

• Nurse Practitioner in Irving, TX
• Providers in Irving, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.