Myla Guangco Bacalso

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704200259 Issued in MI

Practice address

50083 Margaret Ave
Macomb, MI 48044-6340

Phone

(586) 412-0838

NPI assigned

Apr 17, 2017

Last updated

Feb 4, 2021By the provider in NPPES

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

Other names 1

• Myla Bacalso Ducusin Former name

Electronic endpoints 1

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

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mbacalso10002@direct.beaumont.edu
• Direct secure messaging: mbacalso1457008@epic00.shdirect.org

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.

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  • NPI 1083833875
  Medicare reassignment NPD
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  • NPI 1235125717

  MI

  Medicare reassignment NPD
• Metro Infectious Disease Consultants LLC

  dba Midc

  • Infectious Disease Physician
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  • NPI 1770307191
  NPD
• Metro Infectious Disease Consultants, LLC

  • Infectious Disease Physician
  • Plymouth, MI
  • NPI 1841530250
  NPD (past)

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1841724929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "248-577-3313",
            "fax_number": "248-577-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50083 MARGARET AVE",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480446340",
            "telephone_number": "586-412-0838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACALSO",
        "first_name": "MYLA",
        "middle_name": "GUANGCO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-17",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704200259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbacalso10002@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "1949 W 12 Mile Rd Ste 100",
            "city": "Berkley",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480721868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MYLA",
            "last_name": "DUCUSIN",
            "middle_name": "BACALSO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Auburn Neurology and Sleep Associates PC (Tracey Morson MD)
• Linda Marie Audia, LMSW
• Michele Lynn Avery
• Ayla Home Care LLC
• Zain Azzo, M.D.
• Tifani Baisden
• Daniela Maria Barbat
• Jartaya Shirley Ann Barnes
• Lorri Barnes
• Tyler Barnes, PA-C

• Family Nurse Practitioner in Macomb, MI
• Providers in Macomb, 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 Feb 4, 2021; 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.