LARYSA TARASHEVSKA WICKMAN M.D
NPI 1063603082
Pediatrics - Pediatric Nephrology in Ann Arbor, MI
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
Specialties & Licenses 2
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
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.
Medicare Billing Reassignment
Medicare enrollment records show Larysa Wickman reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Royal Oak, MI 48073
- Reassigned Medicare billing, Michigan enrollment
- 1,030 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.
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.
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.
ANN ARBOR, MI 48109
ANN ARBOR, MI 48109
ANN ARBOR, MI 48109
ANN ARBOR, MI 48109
ANN ARBOR, MI 48109
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.
Which organization bills Medicare for Larysa Wickman's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Larysa Wickman reassigns Medicare benefits to Beaumont Medical Group- Specialty Services (Royal Oak, MI). 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 Larysa Wickman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
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 2 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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years 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.
# Larysa Tarashevska Wickman, M.D · NPI 1063603082
Pediatric Nephrology physician in Ann Arbor, Michigan. Individual provider, active in the CMS NPPES registry since August 6, 2007.
## Identity
- **NPI:** 1063603082 (Entity type: Individual)
- **Enumerated:** August 6, 2007
- **Primary specialty:** Pediatrics - Pediatric Nephrology · taxonomy 2080P0210X
- **State license:** 4301089772 (Michigan)
- **Sole proprietor:** No
## Practice location
- **Address:** 1500 E MEDICAL CENTER DR, 1ST FLOOR TAUBMAN CENTER RECP D, Ann Arbor, MI 48109-5318
- **Phone:** (734) 936-4210
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Beaumont Medical Group- Specialty Services (NPI 1578072906, Royal Oak, MI), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1996
## Record status
- **NPPES last updated:** October 20, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1063603082) · Data from the CMS NPPES public registry.