NPIMap

Individual provider Active NPI

Christopher R Deangelis, DO

  • Internal Medicine Physician
  • Trenton, MI
National Provider Identifier
1629076450
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
CD013396 Issued in MI
Practice address
25000 Hall Rd
Ste 1
Trenton, MI 48183-5112
Phone
(734) 676-3373
Fax
(734) 676-2014
NPI assigned
Jul 14, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 CD013396 MI Primary

Addresses

Primary practice location

25000 Hall Rd
Ste 1
Trenton, MI 48183-5112

Mailing address

25000 Hall Rd
Ste 1
Trenton, MI 48183-5112
Phone (734) 676-3373

Other identifiers 9

IdentifierTypeStateIssuer
P109110OtherBCN
38-3510876OtherTAX ID#
1172589003OtherCIGNA
5390707OtherAETNA
1158206834OtherBCBS
C8111OtherM-CARE
CD013396OtherSTATE LIC#
P127746OtherCARE CHOICES
110218319OtherRAILROAD

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
I20080313000300 MI Practitioner - Internal Medicine 1254416324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Street Physicians PCGroup PAC ID 6709125693, 2 clinicians

Practice addresses (Care Compare)

25000 Hall Rd
Suite 1
Woodhaven, MI 48183-5112
Phone (734) 676-3373

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CD013396MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baco Care Services LLC Internal Medicine CurrentSince Mar 1, 2025 Accepting new patients
Main Street Physicians P.C. Internal Medicine CurrentSince Jan 23, 2019 Accepting new patients
Pulmonary and Sleep Medicine PC Past Accepting new patients

Locations

26911 Northwestern Hwy
Ste 530
Southfield, MI 48033
Phone (313) 530-5494

25000 Hall Rd
Ste 1
Woodhaven, MI 48183
Phone (734) 675-1280

25000 Hall Rd
#1
Woodhaven, MI 48183
Phone (734) 675-1280

Interoperability endpoints

  • Direct secure messaging: cdeangelis57490@direct.hfhs.org
  • FHIR API: https://api.platform.athenahealth.com/18753/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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 10

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": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1629076450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25000 HALL RD",
            "address_2": "STE 1",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481835112",
            "telephone_number": "734-676-3373",
            "fax_number": "734-676-2014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25000 HALL RD",
            "address_2": "STE 1",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481835112",
            "telephone_number": "734-676-3373",
            "fax_number": "734-676-2014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEANGELIS",
        "first_name": "CHRISTOPHER",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "CD013396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P109110",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#",
            "identifier": "38-3510876",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1172589003",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5390707",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1158206834",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M-CARE",
            "identifier": "C8111",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC#",
            "identifier": "CD013396",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "P127746",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "110218319",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trenton, MI

Sources for this page

Verify at the official NPI Registry.