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MIMILY HARSONO MD
NPI 1003137571
Pediatrics - Neonatal-Perinatal Medicine in Memphis, TN

Active since June 18, 2010PECOS Enrolled
877 JEFFERSON AVE, MEMPHIS, TN 38103(901) 545-7100 Get Directions Write a Review

NPPES record last updated: February 25, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 25, 2025, Oct 8, 2018 (2 updates tracked since 2018).

About Mimily Harsono Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIMILY HARSONO MD (NPI 1003137571) is an individual neonatal-perinatal medicine provider in Memphis, Tennessee, licensed in Tennessee (50025) and active in the NPI registry since June 2010. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1003137571
Entity TypeIndividualFemale
Primary Taxonomy2080N0001X
Provider Legal NameMIMILY HARSONOCredential: MD
Location Address877 JEFFERSON AVEMemphis, TN 38103-2807
Mailing Address1068 Cresthaven Rd Ste 300Memphis, TN 38119-0809
Phone(901) 545-7100
Sole ProprietorNo
Enumeration DateJune 18, 2010
Last NPPES UpdateFebruary 25, 20252 updates tracked since enumeration
NPPES CertifiedFebruary 25, 2025
✔ NPI 1003137571 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Neonatal-Perinatal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080N0001X
License✔ Licensed in TN · 50025
Definition
A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
877 JEFFERSON AVE, Memphis, TN 38103
Open in Google Maps ↗

Other Identifiers 7

Medicaid197560001AR
Medicaid177423AL
Medicaid1003137571MI
Medicaid02507295MS
Medicaid00179412AGA
Medicaid1003137571MO
Medicaid1532008TN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mimily Harsono Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JESSICA DORAN DNP, CRNA
Nurse Anesthetist, Certified Registered
877 JEFFERSON AVE
MEMPHIS, TN 38103
Shelby County (901) 448-5893
SHELBY COUNTY HEALTH CARE CORPORATION
Skilled Nursing Facility
877 JEFFERSON AVE, 3RD FLOOR, ADAMS PAVILION
MEMPHIS, TN 38103
Shelby County (901) 515-4300
EDSON RUIZ MD
Pediatrics (Neonatal-Perinatal Medicine)
877 JEFFERSON AVE
MEMPHIS, TN 38103
Shelby County (901) 448-5950
MS. MARLA GIDDENS CRNA
Nurse Anesthetist, Certified Registered
877 JEFFERSON AVE
MEMPHIS, TN 38103
Shelby County (901) 545-7100
MARY BETH HALL-KRASNOVE FNP
Nurse Practitioner (Family)
877 JEFFERSON AVE
MEMPHIS, TN 38103
Shelby County (901) 545-8090
MEGAN TALLEY
Dietitian, Registered
877 JEFFERSON AVE
MEMPHIS, TN 38103
Shelby County (901) 545-7753
COURTNEY H PARKER CRNA
Nurse Anesthetist, Certified Registered
877 JEFFERSON AVE
MEMPHIS, TN 38103
Shelby County (901) 545-7100
NIDHI SHEKAR
Pediatrics (Neonatal-Perinatal Medicine)
877 JEFFERSON AVE
MEMPHIS, TN 38103
Shelby County (901) 545-7100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mimily Harsono's NPI number?

The NPI number for Mimily Harsono is 1003137571. It was assigned to this individual provider in the NPPES registry on June 18, 2010.

Where is Mimily Harsono located?

Mimily Harsono practices at 877 Jefferson Ave, Memphis, TN 38103. The listed phone number is (901) 545-7100.

What is Mimily Harsono's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Neonatal-Perinatal Medicine, with taxonomy code 2080N0001X.

Is Mimily Harsono enrolled in Medicare?

Yes. Mimily Harsono is registered in the Medicare PECOS enrollment system.

What insurance does Mimily Harsono accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee and 2 other insurers list Mimily Harsono as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mimily Harsono was last updated on February 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.