NPIMap

Individual provider Active NPI

Mikelson Mompremier, M.D.,F.A.C.S.

  • Ophthalmology Physician
  • Desoto, TX
National Provider Identifier
1578706396
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
P7164 Issued in TX
Practice address
1510 N Hampton Rd
Suite 290
Desoto, TX 75115-8300
Phone
(469) 687-5664
NPI assigned
Apr 8, 2009
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X P7164 TX Primary
Retina Specialist (Ophthalmology) Physician 207WX0107X P7164 TX

Addresses

Primary practice location

1510 N Hampton Rd
Suite 290
Desoto, TX 75115-8300

Mailing address

1510 N Hampton Rd Ste 290
Desoto, TX 75115-8300
Phone (469) 687-5664

Other identifiers 2

IdentifierTypeStateIssuer
P7164OtherTXMEDICAL LICENSE
P0198400OtherTXDPS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, IL, MT3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20130828000243 TX Practitioner - Ophthalmology 2062655749 Reassigns benefits to 2 organizations
I20230925001447 IL Practitioner - Ophthalmology 2062655749 Reassigns benefits to 1 organization
I20240702003303 MT Practitioner - Ophthalmology 2062655749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Billings ClinicGroup PAC ID 6002993516, 814 clinicians

Practice addresses (Care Compare)

1510 N Hampton Rd
Suite 290
Desoto, TX 75115-8300
Phone (954) 302-7657

801 N 29TH St
Billings, MT 59101-0905
Phone (406) 238-2500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P7164TXMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Aug 8, 2023 Accepting new patients
Billings Clinic Current Accepting new patients
Billings Clinic CurrentSince Jun 19, 2024 Accepting new patients
Billings Clinic CurrentSince Jun 19, 2024 Accepting new patients
Mompremier Eye Institute, PLLC Ophthalmology CurrentSince Sep 15, 2016 Accepting new patients
Utmb Faculty Group Practice Ophthalmology CurrentSince Jan 16, 2023 Accepting new patients
Billings Clinic Past Accepting new patients

Locations

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

2800 10th Ave N
Billings, MT 59101
Phone (406) 248-3290

801 N 29th St
Billings, MT 59101
Phone (406) 238-2210

1510 N Hampton Rd
Ste 290
Desoto, TX 75115
Phone (469) 687-5664

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

700 University Blvd
Galveston, TX 77550
Phone (281) 338-0829

511 Park Grove Dr
Katy, TX 77450
Phone (281) 398-7001

200 Blossom St
Webster, TX 77598
Phone (281) 252-7000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19383/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mmompremiermd57865@direct.utmb.edu

Organizations & group practices 7

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

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1578706396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 N HAMPTON RD STE 290",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751158300",
            "telephone_number": "469-687-5664",
            "fax_number": "469-317-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 N HAMPTON RD",
            "address_2": "SUITE 290",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751158300",
            "telephone_number": "469-687-5664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOMPREMIER",
        "first_name": "MIKELSON",
        "name_prefix": "Dr.",
        "credential": "M.D.,F.A.C.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-08",
        "last_updated": "2023-03-07",
        "certification_date": "2021-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "P7164",
            "primary": true
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "TX",
            "license": "P7164",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "P7164",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPS",
            "identifier": "P0198400",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Desoto, TX

Sources for this page

Verify at the official NPI Registry.