Plastic and Reconstructive Surgery

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

140000491 Issued in CA

Legal business name

PLASTIC AND RECONSTRUCTIVE SURGERY

Practice address

1387 Santa Rita Rd
Pleasanton, CA 94566-5643

Phone

(925) 462-3700

Fax

(925) 462-4681

NPI assigned

Jul 2, 2006

Last updated

May 9, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Judi Hicklin

Title

Administrator

Phone

(925) 462-3700

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043249972. Details of each certification follow.

• CCN 55C0001004 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 55C0001004

Legal name

PLASTIC & RECONSTRUCTIVE SURGE

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Aug 22, 1985

Last certification

Oct 12, 2017

Ownership / control type

Proprietary

Facility address

1387 Santa Rita Road
Pleasanton, CA 94566

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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.

• Ronald Edward Iverson, M.D.

  • Plastic Surgery Physician
  • Pleasanton, CA
  • NPI 1316992373
  NPD (past)

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336521600000",
    "number": "1043249972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1387 SANTA RITA RD",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945665643",
            "telephone_number": "925-462-3700",
            "fax_number": "925-462-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1387 SANTA RITA RD",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945665643",
            "telephone_number": "925-462-3700",
            "fax_number": "925-462-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC AND RECONSTRUCTIVE SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2012-05-09",
        "status": "A",
        "authorized_official_last_name": "HICKLIN",
        "authorized_official_first_name": "JUDI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "925-462-3700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "140000491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051102",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Physiotherapy Associates Inc (Select Physical Therapy)
• David Rafael Pichardo-Gomez, MD, MPH
• Danielle Pierre
• Luz Maria Pimentel, DC
• Roger D. Pirtle, LCSW
• Erin Platt, MOTRL
• Pleasanton Allergy and Dermatology Inc
• Pleasanton Diagnostic Imaging, Inc.
• Pleasanton Emergency Medical Group
• Pleasanton Medical Group

• Ambulatory Surgical Clinic/Center in Pleasanton, CA
• Providers in Pleasanton, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.