LARYSA TARASHEVSKA WICKMAN M.D
NPI 1063603082
Pediatrics - Pediatric Nephrology in Ann Arbor, MI

Active since August 06, 2007PECOS EnrolledAccepts Medicare Assignment
80.99/100
CMS Quality Rating
1500 E MEDICAL CENTER DR, 1ST FLOOR TAUBMAN CENTER RECP D, ANN ARBOR, MI 48109(734) 936-4210 Get Directions Write a Review

NPPES record last updated: October 20, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Oct 20, 2020, Sep 12, 2019 (2 updates tracked since 2019).

About Larysa Tarashevska Wickman M.d NPPES

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

LARYSA TARASHEVSKA WICKMAN M.D (NPI 1063603082) is an individual pediatric nephrology provider in Ann Arbor, Michigan, licensed in Michigan (4301089772) and active in the NPI registry since August 2007. She is enrolled in Medicare PECOS, maintains a secondary practice location in Royal Oak, and is a graduate of Other (1996).

NPPES Registry Identity

NPI1063603082
Entity TypeIndividualFemale
Primary Taxonomy2080P0210X
Provider Legal NameLARYSA TARASHEVSKA WICKMANCredential: M.D
Location Address1500 E MEDICAL CENTER DR, 1ST FLOOR TAUBMAN CENTER RECP DAnn Arbor, MI 48109-5318
Mailing Address3621 S State St, 700 Kms PlaceAnn Arbor, MI 48108 · (734) 936-2047
Sole ProprietorNo
Medical School CMSOtherGraduated 1996
Enumeration DateAugust 6, 2007
Last NPPES UpdateOctober 20, 20202 updates tracked since enumeration
NPPES CertifiedOctober 20, 2020
NPI 1063603082 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPediatrics · Pediatric NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code2080P0210X
License Licensed in MI · 4301089772
Definition
A pediatrician who deals with the normal and abnormal development and maturation of the kidney and urinary tract, the mechanisms by which the kidney can be damaged, the evaluation and treatment of renal diseases, fluid and electrolyte abnormalities, hypertension and renal replacement therapy.
Also ListedPediatricsTaxonomy 208000000X · License 4301089772 (MI)
1500 E MEDICAL CENTER DR, Ann Arbor, MI 48109

Secondary Practice Location 1

Location 13535 W 13 Mile Rd Ste 707Royal Oak, MI 48073-6770 · Phone (248) 551-0487 · Fax (248) 551-3696

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Larysa Tarashevska Wickman M.d is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2264627827
PECOS Enrollment IDI20101109001479
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

80.99/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality67.25
Promoting Interoperability100
Improvement Activities40
Cost59.73

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.

Pathology (Forensic Pathology)
1500 E MEDICAL CENTER DR, 2ND FLOOR UNIVERSITY HOSPITAL RECP PATHOLOGY
ANN ARBOR, MI 48109
Internal Medicine (Gastroenterology)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Pathology (Cytopathology)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Pediatrics
1500 E MEDICAL CENTER DR, 12TH FLOOR C.S. MOTT CHILDREN'S HOSPITAL ROOM 525
ANN ARBOR, MI 48109
Pediatrics (Pediatric Infectious Diseases)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Physician Assistant
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Nurse Anesthetist, Certified Registered
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Family Medicine (Hospice and Palliative Medicine)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109

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 Larysa Wickman's NPI number?

The NPI number for Larysa Wickman is 1063603082. It was assigned to this individual provider in the NPPES registry on August 6, 2007.

Where is Larysa Wickman located?

Larysa Wickman practices at 1500 E Medical Center Dr 1st Floor Taubman Center Recp D, Ann Arbor, MI 48109. The listed phone number is (734) 936-4210.

What is Larysa Wickman's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Nephrology, with taxonomy code 2080P0210X.

Is Larysa Wickman enrolled in Medicare?

Yes. Larysa Wickman is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Larysa Wickman accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 3 other insurers list Larysa Wickman 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 Larysa Wickman was last updated on October 20, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.