NPIMap

Individual provider Active NPI

Lusine B Kirakosyan, MD

  • Neurology Physician
  • Roseville, MI
National Provider Identifier
1669737961
Registry record updated May 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301100589 Issued in MI
Practice address
25100 Kelly Rd
Roseville, MI 48066
Phone
(586) 771-7440
Fax
(586) 771-9966
NPI assigned
Jul 12, 2012
Last updated
May 21, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301100589 MI
Neurology Physician 2084N0400X 4301100589 MI Primary

Addresses

Primary practice location

25100 Kelly Rd
Roseville, MI 48066

Mailing address

893 Lafayette CT
Rochester Hills, MI 48307-2919
Phone (910) 546-1771

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
I20171026001783 MI Practitioner - Neurology 2264734243 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Current Accepting new patients
W.a. Foote Memorial Hospital, Inc Neurology CurrentSince Apr 1, 2020 Accepting new patients
W. a. Foote Memorial Hospital, Inc. Neurology Current Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Jul 14, 2020 Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Apr 1, 2020 Accepting new patients
Henry Ford Health System Neurology CurrentSince Apr 9, 2019 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Jul 14, 2020 Accepting new patients
Henry Ford Health System CurrentSince Apr 9, 2019 Accepting new patients

Locations

23050 West Rd
Ste 120
Brownstown Twp, MI 48183
Phone (734) 671-1510

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

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

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482

2333 Biddle Ave
Wyandotte, MI 48192
Phone (734) 246-6000

Interoperability endpoints

  • Direct secure messaging: ldesjardins486181@direct.hfhs.org

Organizations & group practices 8

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 4

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": "1342051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526860800000",
    "number": "1669737961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "893 LAFAYETTE CT",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483072919",
            "telephone_number": "910-546-1771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25100 KELLY RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "48066",
            "telephone_number": "586-771-7440",
            "fax_number": "586-771-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRAKOSYAN",
        "first_name": "LUSINE",
        "middle_name": "B",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-12",
        "last_updated": "2018-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301100589",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301100589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.