Individual provider Active NPI

Chelsey Michelle Eisenga

  • Family Nurse Practitioner
  • Dearborn, MI
National Provider Identifier
1699309690
Registry record updated Feb 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704309584 Issued in MI
Practice address
5250 Auto Club Dr Ste 300
Dearborn, MI 48126-2619
Phone
(313) 724-9000
Fax
(313) 908-9318
NPI assigned
Feb 27, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704309584 MI
Family Nurse Practitioner 363LF0000X 4704309584 MI Primary

Addresses

Primary practice location

5250 Auto Club Dr Ste 300
Dearborn, MI 48126-2619

Mailing address

5250 Auto Club Dr Ste 300
Dearborn, MI 48126-2619
Phone (313) 724-9000

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210219001530 MI Practitioner - Nurse Practitioner 1456766690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Wayne State University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elias H Kassab MD PLLCGroup PAC ID 8123257987, 10 clinicians

Practice addresses (Care Compare)

5250 Auto Club Dr
Suite 300
Dearborn, MI 48126-2619
Phone (313) 724-9000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704309584MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Elias H Kassab MD PLLC CurrentSince Feb 15, 2021 Accepting new patients

Locations

1695 12 Mile Rd
Ste 245
Berkley, MI 48072
Phone (248) 307-7275

5250 Auto Club Dr
Ste 300
Dearborn, MI 48126
Phone (313) 724-9000

5479 Schaefer Rd
Dearborn, MI 48126
Phone (313) 357-2225

645 Barclay Cir
Rochester Hills, MI 48307
Phone (248) 829-1956

9029 Pardee Rd
Taylor, MI 48180
Phone (313) 292-8400

Interoperability endpoints

  • Direct secure messaging: ceisenga1126068@direct.hfhs.org

Organizations & group practices 1

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 5

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": "1582761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1699309690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5250 AUTO CLUB DR STE 300",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262619",
            "telephone_number": "313-724-9000",
            "fax_number": "313-908-9318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 AUTO CLUB DR STE 300",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262619",
            "telephone_number": "313-724-9000",
            "fax_number": "313-908-9318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISENGA",
        "first_name": "CHELSEY",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-27",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704309584",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704309584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.