Individual provider Active NPI

Lena Antoski, MS, RN, AGPCNP-BC

  • Nurse Practitioner
  • Macomb, MI
National Provider Identifier
1861817348
Registry record updated Feb 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704253119 Issued in MI
Practice address
56491 Broadmoor LN
Macomb, MI 48042-1193
Phone
(596) 321-2240
NPI assigned
Feb 20, 2014
Last updated
Feb 20, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704253119 MI Primary

Addresses

Primary practice location

56491 Broadmoor LN
Macomb, MI 48042-1193

Mailing address

56491 Broadmoor LN
Macomb, MI 48042-1193
Phone (596) 321-2240

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
I20140919001504 MI Practitioner - Nurse Practitioner 2860611001 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charles G Kissel DPM PCGroup PAC ID 9436167814, 9 clinicians

Practice addresses (Care Compare)

29433 Ryan Rd
Warren, MI 48092-2203
Phone (586) 574-0500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner, Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Charles G Kissel DPM PC CurrentSince Apr 1, 2018 Accepting new patients
Michel Hanna MD PC CurrentSince Aug 9, 2014 Accepting new patients

Locations

1701 South Blvd E
Ste 190
Rochester Hills, MI 48307
Phone (248) 289-1509

43200 Dequindre Rd
Ste 102
Sterling Heights, MI 48314
Phone (586) 731-8200

29433 Ryan Rd
Warren, MI 48092
Phone (586) 574-0500

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
  • Direct secure messaging: lantoski285207@direct.hfhs.org
  • Direct secure messaging: lena.antoski@cgkdp-mi.direct.office.nextgen.com

Organizations & group practices 2

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 3

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": "1392854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392854400000",
    "number": "1861817348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56491 BROADMOOR LN",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480421193",
            "telephone_number": "596-321-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56491 BROADMOOR LN",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480421193",
            "telephone_number": "596-321-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTOSKI",
        "first_name": "LENA",
        "name_prefix": "Mrs.",
        "credential": "MS, RN, AGPCNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-20",
        "last_updated": "2014-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704253119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macomb, MI

Sources for this page

Verify at the official NPI Registry.