MICHELLE OLGA MIRONOVICH
NPI 1881441962
Physician Assistant in Green Bay, WI

Q: What is Michelle Mironovich's NPI number?

The NPI number for Michelle Mironovich is 1881441962. It was assigned to this individual provider in the NPPES registry on May 6, 2024.

Q: What is Michelle Mironovich's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Active since May 06, 2024PECOS EnrolledAccepts Medicare Assignment

1110 KEPLER DR, GREEN BAY, WI 54311(920) 288-5555(920) 288-5550 Get Directions Write a Review

NPPES record last updated: May 7, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 7, 2026, Sep 3, 2025, May 6, 2024 (3 updates tracked since 2024).

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About Michelle Olga Mironovich NPPES

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

MICHELLE OLGA MIRONOVICH (NPI 1881441962) is an individual physician assistant in Green Bay, Wisconsin, licensed in Wisconsin (8641) and active in the NPI registry since May 2024. She is enrolled in Medicare PECOS, is affiliated with Aurora Baycare Medical Ctr, and maintains a secondary practice location in Green Bay.

NPPES Registry Identity

NPI1881441962

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMICHELLE OLGA MIRONOVICH

Location Address1110 KEPLER DRGreen Bay, WI 54311-8306

Mailing Address1035 Kepler DrGreen Bay, WI 54311-8320 · (920) 490-9046 · Fax (920) 405-8005

Phone(920) 288-5555

Fax(920) 288-5550

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateMay 6, 2024

Last NPPES UpdateMay 7, 20263 updates tracked since enumeration

NPPES CertifiedMay 7, 2026

✔ NPI 1881441962 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in WI · 8641

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1110 KEPLER DR, Green Bay, WI 54311

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Secondary Practice Location 1

Location 12502 S Ashland AveGreen Bay, WI 54304-5252 · Phone (651) 635-8000

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

Michelle Olga Mironovich 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 ID547758948

PECOS Enrollment IDI20251017003766

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Aurora Baycare Medical Ctr

Acute Care Hospitals · Green Bay, WI

5/5 CMS rating

OwnershipProprietary

CMS Certification Number520193

Location2845 Greenbrier RdGreen Bay, WI 54311 · Brown County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54311 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

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.

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.

MIKALA M RUBO OT

Occupational Therapist