Individual provider Active NPI

Nitika Mimani, MD

  • Pediatrics Physician
  • Austin, TX
National Provider Identifier
1215344676
Registry record updated Aug 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
R2018 Issued in TX
Practice address
1807 W Slaughter LN Ste 490
Austin, TX 78748-6208
Phone
(512) 282-8967
Fax
(512) 406-7351
NPI assigned
Jul 17, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R2018 TX Primary

Addresses

Primary practice location

1807 W Slaughter LN Ste 490
Austin, TX 78748-6208

Mailing address

4515 Seton Center Pkwy Ste 215
Austin, TX 78759-5785
Phone (512) 338-3826

Other identifiers 3

IdentifierTypeStateIssuer
371153301MedicaidTX
371153303MedicaidTX
371153302MedicaidTX

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170612002358 TX Practitioner - Pediatric Medicine 9931477148 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R2018TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Regional Clinic, PA Pediatrics CurrentSince Oct 11, 2018 Accepting new patients
Austin Regional Clinic, PA CurrentSince Oct 11, 2018 Accepting new patients
Seton Hospitalist Service Past Accepting new patients

Locations

1807 W Slaughter Ln
Ste 490
Austin, TX 78748
Phone (512) 282-8967

6835 Austin Center Blvd
Austin, TX 78731
Phone (512) 231-5210

4515 Seton Center Pkwy
Ste 215
Austin, TX 78759
Phone (512) 338-3802

6210 E Highway 290
Austin, TX 78723

151 Exchange Blvd
Ste 500
Hutto, TX 78634
Phone (512) 846-1244

940 Hesters Crossing Rd
Round Rock, TX 78681
Phone (512) 244-9024

Interoperability endpoints

  • Direct secure messaging: nsoni20650@arcmd.direct-ci.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1405555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628380800000",
    "number": "1215344676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 SETON CENTER PKWY STE 215",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787595785",
            "telephone_number": "512-338-3826",
            "fax_number": "512-406-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 W SLAUGHTER LN STE 490",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787486208",
            "telephone_number": "512-282-8967",
            "fax_number": "512-406-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMANI",
        "first_name": "NITIKA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-17",
        "last_updated": "2021-08-08",
        "certification_date": "2021-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "R2018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371153301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371153303",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371153302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.