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DR. JUDITH K MICKELSON M.D.
NPI 1700876190
Internal Medicine - Cardiovascular Disease in Cottleville, MO

Active since October 26, 2005PECOS Enrolled
117 TRAIL CREEK CT, COTTLEVILLE, MO 63304(513) 543-0595 Get Directions Write a Review

NPPES record last updated: March 12, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 12, 2025, Apr 2, 2024, Oct 14, 2021 and 1 more (4 updates tracked since 2020).

About Dr. Judith K Mickelson M.d. NPPES

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

DR. JUDITH K MICKELSON M.D. (NPI 1700876190) is an individual cardiovascular disease provider in Cottleville, Missouri, licensed in Missouri (2017039388) and active in the NPI registry since October 2005. She is enrolled in Medicare PECOS and maintains a secondary practice location in Saint Louis.

NPPES Registry Identity

NPI1700876190
Entity TypeIndividualFemale
Primary Taxonomy207RC0000X
Provider Legal NameDR. JUDITH K MICKELSONCredential: M.D.
Location Address117 TRAIL CREEK CTCottleville, MO 63304-7594
Mailing Address117 Trail Creek CtCottleville, MO 63304-7594 · (513) 543-0595
Phone(513) 543-0595
Sole ProprietorNo
Enumeration DateOctober 26, 2005
Last NPPES UpdateMarch 12, 20254 updates tracked since enumeration
NPPES CertifiedMarch 12, 2025
✔ NPI 1700876190 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RC0000X
Licenses✔ Licensed in MO · 2017039388✔ Licensed in OH · 35-078636
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Also ListedSpecialistTaxonomy 174400000X · License 35-078636 (OH), MD24100 (ME)
117 TRAIL CREEK CT, Cottleville, MO 63304
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Secondary Practice Location 1

Location 1915 N Grand BlvdSaint Louis, MO 63106-1621 · Phone (314) 652-4100

Other Identifiers 2

Medicaid2209176OH
Other060068472Railroad Medicare

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Judith K Mickelson M.d. 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.

Medicare Billing Reassignments

2

Medicare enrollment records show Judith Mickelson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mercy Clinic Springfield Communities
61 mi
Rural Health
114 DOWNEY PL
Cuba, MO 65453
  • Reassigned Medicare billing, Missouri enrollment
  • 1,487 clinicians in this Medicare group
NPI 1063541704 (573) 885-3358
Central Maine Medical Center
1,122 mi
General Acute Care Hospital
300 MAIN ST
Lewiston, ME 04240
  • Reassigned Medicare billing, Maine enrollment
  • 920 clinicians in this Medicare group
NPI 1689653487 (207) 795-5646

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 63304 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$128.28 typical visit price
range $55.65 – $169.38
Typical copayment $32.07 (range $13.91 – $42.34)
Most-billed visit code 99204
Established Patient
$69.50 typical visit price
range $17.76 – $137.92
Typical copayment $17.37 (range $4.44 – $34.48)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Judith Mickelson's NPI number?

The NPI number for Judith Mickelson is 1700876190. It was assigned to this individual provider in the NPPES registry on October 26, 2005.

Where is Judith Mickelson located?

Judith Mickelson practices at 117 Trail Creek Ct, Cottleville, MO 63304. The listed phone number is (513) 543-0595.

What is Judith Mickelson's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Is Judith Mickelson enrolled in Medicare?

Yes. Judith Mickelson is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Judith Mickelson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Judith Mickelson reassigns Medicare benefits to 2 organizations: Mercy Clinic Springfield Communities (Cuba, MO) and Central Maine Medical Center (Lewiston, ME). Each 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 Judith Mickelson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Judith Mickelson was last updated on March 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.