MIMI SONG IDICULA NP NPI 1003009580

Nurse Practitioner in Irving, TX

NPI 1003009580 Individual Female Years of Experience 5 Nurse Practitioner PECOS Enrolled Accepts Medicare Approved Payment

About MIMI IDICULA

Mimi Idicula is a provider established in Irving, Texas and her medical specialization is nurse practitioner with more than 5 years of experience. The NPI number of Mimi Idicula is 1003009580 and was assigned on August 2007. The practitioner's primary taxonomy code is 363L00000X with license number AP137449 (TX). The provider is registered as an individual and her NPI record was last updated July 2021.

A nurse practitioner (NP) like Mimi Song Idicula Np is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Mimi Idicula is enrolled in PECOS and is eligible to order or refer healthcare services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices

Mimi Idicula is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

NPI

1003009580

Provider Name MIMI SONG IDICULA NP
Provider Location Address6161 N STATE HIGHWAY 161 IRVING, TX 75038
Provider Mailing Address6161 N STATE HIGHWAY 161 IRVING, TX 75038
GenderFemale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year2017
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date08-20-2007
Last Update Date07-13-2021


Primary Taxonomy

Taxonomy Code363L00000X
ClassificationNurse Practitioner
TypePhysician Assistants & Advanced Practice Nursing Providers
License No.AP137449
License StateTX
Taxonomy Description(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Business Address

MIMI SONG IDICULA NP
6161 N STATE HIGHWAY 161
IRVING, TX
ZIP 75038
Phone: (972) 258-7499
Fax: (972) 257-0897

Get Directions


Mailing Address

MIMI SONG IDICULA NP
6161 N STATE HIGHWAY 161
IRVING, TX
ZIP 75038
Phone: (972) 258-7499
Fax: (972) 257-0897



Secondary Locations

1717 W University Dr #408
McKinney, TX 75069
(972) 548-2600

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1111N00000XChiropractic ProvidersChiropractor10049TXNo

Taxonomy Description: a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
AP137449OTHER (01)TX

Other Providers at the same location


The following 15 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1083687206 MARY C WARD D.O.
Individual
Family Medicine6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1073589586DR. MARIA NICOLA BIARD MD
Individual
Family Medicine6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1225004351DR. JAMES MARK ANDERSON MD
Individual
Family Medicine6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1760458897DR. CHARLES LEE POWELL MD
Individual
Family Medicine6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1780650291DR. WALTER NICHOLAS GAMAN MD
Individual
Family Medicine6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1346466943 CESAR O. TORRES MD
Individual
Family Medicine6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1043458631 ABIGAIL LEWADOWSKI SOTO PA-C
Individual
Physician Assistant (Medical)6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1639309461 STACY R. MORETTA P.A.
Individual
Physician Assistant (Medical)6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1326363128 RANDI DAWN TRUE PA
Individual
Physician Assistant6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1316262033MRS. JENNIFER GARCIA MATA PA-C
Individual
Physician Assistant6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1508388679 CINDI ANN PETERS RN
Individual
Nurse Practitioner (Family)6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1700255684 TABETHA MASLOW MSN, APRN, FNP-C
Individual
Nurse Practitioner (Family)6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499
1073712329HEALTHCARE ASSOCIATES OF IRVING
Organization
Pharmacy (Community/Retail Pharmacy)6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 812-7559
1154952133MR. GEORGE LARRY JONES JR. RPH
Individual
Pharmacist6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 812-7599
1467413625HEALTHCARE ASSOCIATES OF IRVING LLP
Organization
Family Medicine6161 N STATE HIGHWAY 161
IRVING, TX 75038
(972) 258-7499

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.