NPIMap

Individual provider Active NPI

Lisa B. Elconin, M.D.

  • Internal Medicine Physician
  • West Bloomfield, MI
National Provider Identifier
1124095880
Registry record updated Aug 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301060119 Issued in MI
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
Last updated
Aug 5, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
Premier Therapy Centers, IncGroup PAC ID 5092605717, 140 clinicians

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301060119MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Healthcare Professionals PC CurrentSince May 2, 2020 Accepting new patients
Michigan Healthcare Professionals PC Internal Medicine Current Accepting new patients
Michigan Healthcare Professionals PC CurrentSince May 2, 2020 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

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
  • Direct secure messaging: lelconin59533@direct.hfhs.org
  • Direct secure messaging: 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bloomfield, MI

Sources for this page

Verify at the official NPI Registry.