MIMI TYSON
NPI 1952960924
Nurse Practitioner - Psychiatric/Mental Health in North Bethesda, MD
About Mimi Tyson NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MIMI TYSON (NPI 1952960924) is an individual psychiatric/mental health provider in North Bethesda, Maryland, licensed in Virginia (0024177697) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2019).
NPPES Registry Identity
Specialties & Licenses
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
Mimi Tyson 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 Mimi Tyson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
North Bethesda, MD 20852
- Reassigned Medicare billing, District of Columbia enrollment
- 3 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.
Areas of Expertise CMS Part B claims 3
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 20852 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 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
NORTH BETHESDA, MD 20852
NORTH BETHESDA, MD 20852
ROCKVILLE, MD 20852
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 Tyson's NPI number?
The NPI number for Mimi Tyson is 1952960924. It was assigned to this individual provider in the NPPES registry on June 12, 2019.
Where is Mimi Tyson located?
Mimi Tyson practices at 6010 Executive Blvd Ste 700, North Bethesda, MD 20852. The listed phone number is (301) 392-7120.
What is Mimi Tyson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Mimi Tyson enrolled in Medicare?
Yes. Mimi Tyson 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 Mimi Tyson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mimi Tyson reassigns Medicare benefits to Cervello-Wellness, LLC (North Bethesda, MD). 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 Tyson'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 Mimi Tyson was last updated on February 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 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.
# Mimi Tyson · NPI 1952960924
Psychiatric/Mental Health physician in North Bethesda, Maryland. Individual provider, active in the CMS NPPES registry since June 12, 2019.
## Identity
- **NPI:** 1952960924 (Entity type: Individual)
- **Enumerated:** June 12, 2019
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 0024177697 (Virginia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 6010 EXECUTIVE BLVD STE 700, North Bethesda, MD 20852-3885
- **Phone:** (301) 392-7120 · **Fax:** (301) 259-3820
## 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:** Cervello-Wellness, LLC (NPI 1083239255, North Bethesda, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2019
## Record status
- **NPPES last updated:** February 3, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1952960924) · Data from the CMS NPPES public registry.