Mellissa Sue Ivy, ARNP is a medicare enrolled "Nurse Practitioner - Gerontology" physician in Spokane, Washington. Her current practice location is
101 W 8th Ave, Spokane, Washington. You can reach out to her office (for appointments etc.) via phone at
(509) 474-3260.
Mellissa Sue Ivy is licensed to practice in Washington (license number AP61216242) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1730815960.
Physician's Profile
| Full Name | Mellissa Sue Ivy |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Gerontology |
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| Location | 101 W 8th Ave, Spokane, Washington |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1730815960
- Provider Enumeration Date: 07/29/2022
- Last Update Date: 05/02/2024
Medicare PECOS Information:
- PECOS PAC ID: 0648649152
- Enrollment ID: I20221205002915
Medical Identifiers
Medical identifiers for Mellissa Sue Ivy such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1730815960 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207R00000X | Internal Medicine | 61216242 (Washington) | Secondary |
| 363LA2100X | Nurse Practitioner - Acute Care | AP61216242 (Washington) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | AP61216242 (Washington) | Secondary |
| 363LG0600X | Nurse Practitioner - Gerontology | AP61216242 (Washington) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mellissa Sue Ivy allows following entities to bill medicare on her behalf.
| Entity Name | Kingman Healthcare Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1265423917
PECOS PAC ID: 6901791367
Enrollment ID: O20040216001173 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mellissa Sue Ivy is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mellissa Sue Ivy, ARNP
Po Box 421,
Liberty Lake, WA 99019-0421
Ph: (866) 747-2455 | Mellissa Sue Ivy, ARNP
101 W 8th Ave,
Spokane, WA 99204-2307
Ph: (509) 474-3260 |
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