Organization Active NPI

Plastic Surgical Arts PC

  • Plastic Surgery Physician
  • Lincoln, NE
National Provider Identifier
1013936012
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
PLASTIC SURGICAL ARTS PC
Practice address
4400 Lucile Dr Ste 103
Lincoln, NE 68516-4211
Phone
(402) 483-2572
Fax
(402) 483-2619
NPI assigned
Jul 19, 2006
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Tina Olivares
Title
Manager
Phone
(402) 483-2572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

4400 Lucile Dr Ste 103
Lincoln, NE 68516-4211

Mailing address

4400 Lucile Dr Ste 103
Lincoln, NE 68516-4211
Phone (402) 483-2572

Other identifiers 1

IdentifierTypeStateIssuer
CG2908OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050720000692 NE Part B Supplier - Clinic/Group Practice 8123055225 Receives reassigned benefits from 2 practitioners
Practice locations: Lincoln, NE

National Provider Directory

National Provider Directory

Locations

1730 S 70th St
Ste 210
Lincoln, NE 68506
Phone (402) 483-2572

4400 Lucile Dr
Ste 103
Lincoln, NE 68516
Phone (402) 483-2572

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1013936012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 LUCILE DR STE 103",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685164211",
            "telephone_number": "402-483-2572",
            "fax_number": "402-483-2619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 LUCILE DR STE 103",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685164211",
            "telephone_number": "402-483-2572",
            "fax_number": "402-483-2619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGICAL ARTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "OLIVARES",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "402-483-2572"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG2908",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.