MIMI KIM SONG MSN, CNM
NPI 1609398155
Advanced Practice Midwife in Johns Creek, GA
About Mimi Kim Song Msn, Cnm NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MIMI KIM SONG MSN, CNM (NPI 1609398155) is an individual advanced practice midwife in Johns Creek, Georgia, licensed in Georgia (RN213220) and active in the NPI registry since July 2017. She is enrolled in Medicare PECOS and maintains a secondary practice location in Marietta.
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 (PECOS)
Mimi Kim Song Msn, Cnm is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Mimi Song reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Lawrenceville, GA 30046
- Reassigned Medicare billing, Georgia enrollment
- 59 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30097 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 19
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
JOHNS CREEK, GA 30097
JOHNS CREEK, GA 30097
JOHNS CREEK, GA 30097
JOHNS CREEK, GA 30097
JOHNS CREEK, GA 30097
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 Mimi Song's NPI number?
The NPI number for Mimi Song is 1609398155. It was assigned to this individual provider in the NPPES registry on July 15, 2017.
Where is Mimi Song located?
Mimi Song practices at 10692 Medlock Bridge Rd Ste 100A, Johns Creek, GA 30097. The listed phone number is (404) 446-2496.
What is Mimi Song's specialty?
The primary specialty registered for this NPI is Advanced Practice Midwife with taxonomy code 367A00000X.
Is Mimi Song enrolled in Medicare?
Yes. Mimi Song is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Mimi Song's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mimi Song reassigns Medicare benefits to Northside Womens Group LLC (Lawrenceville, GA). 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 Mimi Song's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mimi Song accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Mimi Song 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 Mimi Song was last updated on February 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Mimi Kim Song, MSN, CNM · NPI 1609398155
Advanced Practice Midwife physician in Johns Creek, Georgia. Individual provider, active in the CMS NPPES registry since July 15, 2017.
## Identity
- **NPI:** 1609398155 (Entity type: Individual)
- **Enumerated:** July 15, 2017
- **Primary specialty:** Advanced Practice Midwife · taxonomy 367A00000X
- **State license:** RN213220 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 10692 MEDLOCK BRIDGE RD STE 100A, Johns Creek, GA 30097-8497
- **Phone:** (404) 446-2496
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Northside Womens Group LLC (NPI 1275380701, Lawrenceville, GA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 17, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1609398155) · Data from the CMS NPPES public registry.