Active NPI
Maria Kostritsyna
- Family Medicine Physician
- South Lyon, MI
National Provider Identifier
1649683590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301105440
- Practice address
- 210 N Lafayette St
Providence Medical Center
South Lyon, MI 48178-2048 - Phone
- (248) 849-3441
- NPI assigned
- Jun 9, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301105440 | MI | Primary |
Addresses
Primary practice location
210 N Lafayette St
Providence Medical Center
South Lyon, MI 48178-2048
Mailing address
210 N Lafayette St
Providence Medical Center
South Lyon, MI 48178-2048
Phone (248) 849-3441
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 |
|---|---|---|---|---|
| I20160212000286 | MI | Order and Referring Only - Family Practice | 5395049209 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402272000000",
"number": "1649683590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 N LAFAYETTE ST",
"address_2": "PROVIDENCE MEDICAL CENTER",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481782048",
"telephone_number": "248-849-3441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 N LAFAYETTE ST",
"address_2": "PROVIDENCE MEDICAL CENTER",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481782048",
"telephone_number": "248-849-3441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSTRITSYNA",
"first_name": "MARIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-09",
"last_updated": "2014-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301105440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lyon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.