Michael L. Lastine, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23174 Issued in MN

Practice address

920 4TH Ave SW
Pipestone, MN 56164-1455

Phone

(507) 825-5700

Fax

(507) 825-4752

NPI assigned

Apr 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: michael.lastine@avera.sdhealthlink.net

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380240000000",
    "number": "1306800842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 4TH AVE SW",
            "city": "PIPESTONE",
            "state": "MN",
            "postal_code": "561641455",
            "telephone_number": "507-825-5700",
            "fax_number": "507-825-4752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 4TH AVE SW",
            "city": "PIPESTONE",
            "state": "MN",
            "postal_code": "561641455",
            "telephone_number": "507-825-5700",
            "fax_number": "507-825-4752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASTINE",
        "first_name": "MICHAEL",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2013-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "23174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080056192",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "867592900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7788113",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912212",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Morgan Michaela Mack
• Maria Dunblazier Mental Health Counseling LLC

• Family Medicine Physician in Pipestone, MN
• Providers in Pipestone, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.