MIMILY HARSONO MD
NPI 1003137571
Pediatrics - Neonatal-Perinatal Medicine in Memphis, TN
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
Specialties & Licenses
Other Identifiers 7
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mimily Harsono Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Mimily Harsono reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Memphis, TN 38119
- Reassigned Medicare billing, Tennessee enrollment
- 157 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
MEMPHIS, TN 38103
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.
Which organization bills Medicare for Mimily Harsono's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mimily Harsono reassigns Medicare benefits to Ut Medical Group Inc (Memphis, TN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mimily Harsono's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mimily Harsono accept?
Health plans from BlueCross BlueShield of Tennessee, Cigna Healthcare and Molina Healthcare 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 20 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.
# Mimily Harsono, MD · NPI 1003137571
Neonatal-Perinatal Medicine physician in Memphis, Tennessee. Individual provider, active in the CMS NPPES registry since June 18, 2010.
## Identity
- **NPI:** 1003137571 (Entity type: Individual)
- **Enumerated:** June 18, 2010
- **Primary specialty:** Pediatrics - Neonatal-Perinatal Medicine · taxonomy 2080N0001X
- **State license:** 50025 (Tennessee)
- **Sole proprietor:** No
## Practice location
- **Address:** 877 JEFFERSON AVE, Memphis, TN 38103-2807
- **Phone:** (901) 545-7100
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Ut Medical Group Inc (NPI 1780676650, Memphis, TN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 25, 2025
- **Other identifiers:** Medicaid 197560001 (AR); Medicaid 177423 (AL); Medicaid 1003137571 (MI); and 4 more
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Source: [NPI Profile](https://npiprofile.com/npi/1003137571) · Data from the CMS NPPES public registry.