Active NPI
Lisa B. Elconin, M.D.
- Internal Medicine Physician
- West Bloomfield, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301060119
- Practice address
- 5777 W Maple Rd
Suite 140
West Bloomfield, MI 48322-2267 - Phone
- (248) 406-1000
- Fax
- (248) 406-1001
- NPI assigned
- Mar 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301060119 | MI | Primary |
Addresses
Primary practice location
5777 W Maple Rd
Suite 140
West Bloomfield, MI 48322-2267
Mailing address
5777 W Maple Rd
Suite 140
West Bloomfield, MI 48322-2267
Phone (248) 406-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4619246 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040709001410 | MI | Practitioner - Internal Medicine | 4486632098 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Wayne State University School of Medicine, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
27900 Grand River Ave
Suite 220
Farmington Hills, MI 48336-5965
Phone (248) 477-0552
33010 Northwestern Hwy
West Bloomfield, MI 48322-3634
5777 W Maple Rd
Suite 140
West Bloomfield, MI 48322-2268
Phone (248) 406-1000
Hospital & facility affiliations
- Optimal Care Home Health
- John Paul Home Health Care
- Beaumont Hospital Royal Oak
- Ascension Providence Hospital, Southfield and Novi
- Henry Ford Health West Bloomfield Hospital
- Beaumont Hospital - Farmington Hills
- Henry Ford Health Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michigan Healthcare Professionals PC | Current | Accepting new patients | |
| Michigan Healthcare Professionals PC | Internal Medicine | Current | Accepting new patients |
| Michigan Healthcare Professionals PC | Current | Accepting new patients |
Locations
27900 Grand River Ave
Ste 220
Farmington Hills, MI 48336
Phone (248) 477-0552
29992 Northwestern Hwy
Ste C
Farmington Hills, MI 48334
Phone (248) 851-1430
28455 Haggerty Rd
Ste 102
Novi, MI 48377
Phone (248) 553-0050
1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300
16001 W 9 Mile Rd
Fl 5
Southfield, MI 48075
Phone (248) 380-4335
5777 W Maple Rd
Ste 140
West Bloomfield, MI 48322
Phone (248) 406-1000
Interoperability endpoints
- lelconin59533@direct.hfhs.org
- https://fhir.meditouchehr.com/api/fhir/r4/
- lisa.elconinmd.p1@direct.mhp.nextgenshare.com
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Farmington Hills, MI
- NPI 1295023547
Internal Medicine, MI
-
- Physical Therapy Clinic/Center
- West Bloomfield, MI
- NPI 1962512202
-
- Diagnostic Radiology Physician
- Westland, MI
- NPI 1043559404
-
- Durable Medical Equipment & Medical Supplies
- Lapeer, MI
- NPI 1992693303
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Bingham Farms, MI
- NPI 1609896208
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312502400000",
"number": "1124095880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5777 W MAPLE RD",
"address_2": "SUITE 140",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483222267",
"telephone_number": "248-406-1000",
"fax_number": "248-406-1001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5777 W MAPLE RD",
"address_2": "SUITE 140",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483222267",
"telephone_number": "248-406-1000",
"fax_number": "248-406-1001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELCONIN",
"first_name": "LISA",
"middle_name": "B.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-01",
"last_updated": "2011-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301060119",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4619246",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.