Lisa Mae Mackaluso, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704252035 Issued in MI

Practice address

2601 Electric Ave
Port Huron, MI 48060-6587

Phone

(810) 216-1500

NPI assigned

Jul 9, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ihp Mi Emergency Medicine PLLC

  • Emergency Medicine Physician
  • Garden City, MI
  • NPI 1861147456
  Medicare reassignment NPD

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

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1740852771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606587",
            "telephone_number": "810-216-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606587",
            "telephone_number": "810-216-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1221 Pine Grove Ave",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480603511",
            "country_code": "US",
            "telephone_number": "810-987-5000",
            "fax_number": "810-985-2671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKALUSO",
        "first_name": "LISA",
        "middle_name": "MAE",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-09",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704252035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ke Ma, DO
• John William Macdonald IX
• Laura Roberta Macdonald
• Michelle Macdonald, RN
• Rose Macdonald, LLPC
• Jenna Mackey, PA-C
• Kimia Maddahi, MD
• Madison Community Hospital Inc.
• Beth Marie Maes, PHARM.D.
• Kaitlyn Marie Mahaffy

• Family Nurse Practitioner in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.

Verify at the official NPI Registry.