Individual provider Active NPI

Chona Bacay Lastimosa, M.D.

  • Family Medicine Physician
  • Detroit, MI
National Provider Identifier
1124298047
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301093407 Issued in MI
Practice address
7800 W Outer Dr
Detroit, MI 48235-3461
Phone
(313) 543-6200
Fax
(313) 543-6233
NPI assigned
Mar 6, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301093407 MI Primary

Addresses

Primary practice location

7800 W Outer Dr
Detroit, MI 48235-3461

Mailing address

7800 W Outer Dr
Detroit, MI 48235-3461
Phone (313) 543-6200

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110510000354 MI Practitioner - Family Practice 8426234303 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608

29200 Schoolcraft Rd
Livonia, MI 48150-2228
Phone (734) 523-1050

Hospital & facility affiliations

  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
  • Henry Ford Health West Bloomfield Hospital Hospital, W Bloomfield, MI, CCN 230302

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301093407MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System CurrentSince Jan 17, 2011 Accepting new patients
Prime Hospice & Services, LLC Current Accepting new patients
Henry Ford Health System Current Accepting new patients
Henr Y Ford Health System Family Medicine CurrentSince Jan 17, 2011 Accepting new patients
Henry Ford Pathology Current Accepting new patients

Locations

1961 S Telegraph Rd
Bloomfield Township, MI 48302
Phone (248) 319-6190

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

7800 W Outer Dr
Detroit, MI 48235
Phone (313) 387-8800

39450 W Twelve Mile Rd
Novi, MI 48377
Phone (248) 344-0710

22505 Allen Rd
Woodhaven, MI 48183
Phone (734) 671-6217

Interoperability endpoints

  • Direct secure messaging: clastimosa14249@direct.hfhs.org

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1124298047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7800 W OUTER DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353461",
            "telephone_number": "313-543-6200",
            "fax_number": "313-543-6233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7800 W OUTER DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353461",
            "telephone_number": "313-543-6200",
            "fax_number": "313-543-6233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASTIMOSA",
        "first_name": "CHONA",
        "middle_name": "BACAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-06",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301093407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.