Mrs Melissa Thibault Mikota, APRN, FNP-BC is a medicare enrolled "Nurse Practitioner - Family" in Third Lake, Illinois. Her current practice location is
34344 N Us Highway 45, Third Lake, Illinois. You can reach out to her office (for appointments etc.) via phone at
(847) 543-5440.
Mrs Melissa Thibault Mikota is licensed to practice in Illinois (license number 209010057) 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 1346673910.
Provider's Profile
| Full Name | Mrs Melissa Thibault Mikota |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 34344 N Us Highway 45, Third Lake, Illinois |
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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: 1346673910
- Provider Enumeration Date: 08/18/2013
- Last Update Date: 06/30/2022
Medicare PECOS Information:
- PECOS PAC ID: 9032344544
- Enrollment ID: I20230113000628
Medical Identifiers
Medical identifiers for Mrs Melissa Thibault Mikota such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1346673910 | NPI | - | NPPES |
| 1346673910 | Medicaid | WA | |
| G8923564 | Other | WA | MEDICARE PTAN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LF0000X | Nurse Practitioner - Family | AP133930 (Texas) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 209010057 (Illinois) | 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. Mrs Melissa Thibault Mikota allows following entities to bill medicare on her behalf.
| Entity Name | Minuteclinic Diagnostic Of Illinois Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1356485809
PECOS PAC ID: 8729171566
Enrollment ID: O20070910000607 |
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| Entity Name | Minuteclinic Video Virtual Care North Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1518512227
PECOS PAC ID: 1254762297
Enrollment ID: O20200620000026 |
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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. Mrs Melissa Thibault Mikota 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 |
|---|
Mrs Melissa Thibault Mikota, APRN, FNP-BC
34344 N Us Highway 45,
Third Lake, IL 60030-4031
Ph: (847) 543-5440 | Mrs Melissa Thibault Mikota, APRN, FNP-BC
34344 N Us Highway 45,
Third Lake, IL 60030-4031
Ph: (847) 543-5440 |
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