MELODIE ANNE KABANUK DOHM (APRN-CNP, PMHNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1578029757
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for MELODIE ANNE KABANUK DOHM (APRN-CNP, PMHNP)
1, East 24th Street, Whittier, Minneapolis, Hennepin County, Minnesota, 55404, United States
MINNEAPOLIS, MN 554043959
Phone: (612) 721-9800
Type: Location
2704 MOUNDS VIEW BLVD STE 12
SAINT PAUL, MN 551124366
Phone: (320) 232-0647
Fax: (567) 205-3614
Type: Location
821 RAYMOND AVE STE 335
SAINT PAUL, MN 551141503
Phone: (320) 232-0647
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-10-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20191016002174 | I | Nurse Practitioner | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55404)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Psychologist | CA | |
| Nurse Practitioner | MN | |
| Clinical Psychologist | MN | |
| Clinical Psychologist | MN | |
| - | MN | |
| - | MN | |
| Family Practice | MN | |
| Mental Health Counselor | MN | |
| Nurse Practitioner | MN | |
| Family Practice | WI |
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