Melanie B Illich, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

J2104 Issued in TX

Practice address

5010 Lakeland Circle
Suite B
Waco, TX 76710-2981

Phone

(254) 776-3486

Fax

(254) 776-8466

NPI assigned

Oct 18, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2011 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Melanie Illich MD PA

  • Psychiatry Physician
  • Waco, TX
  • NPI 1699879288
  NPD (past) Authorized official
• Baylor College of Medicine

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1104867175
  NPD (past)

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609632000000",
    "number": "1982893665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5010 LAKELAND CIRCLE",
            "address_2": "SUITE B",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767102981",
            "telephone_number": "254-776-3486",
            "fax_number": "254-776-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5010 LAKELAND CIRCLE",
            "address_2": "SUITE B",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767102981",
            "telephone_number": "254-776-3486",
            "fax_number": "254-776-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLICH",
        "first_name": "MELANIE",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-18",
        "last_updated": "2021-01-03",
        "certification_date": "2021-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "J2104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "G08042",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113408204",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00291G",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Gayle Ibanez, LCSW
• Alex Manuel Ibarra-Morales
• Ideal MRI, LLC
• Patrice Ihry, FNP
• Thomas Masashi Ikeda, OTR L
• Imagine Me 2 B
• Kayla Imbrogno, AA
• Maggie Jane Impastato, MSN,RN, AGACNP-BC
• In Vision Eye Care, LLC (Boa Vision Centers)
• In-Vitro Diagnostics Inc (Serolab)

• Psychiatry Physician in Waco, TX
• Providers in Waco, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.