Plastic Surgicentre, Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

L0712575 Issued in WA

Legal business name

PLASTIC SURGICENTRE, INC

Doing business as

The Plastic SurgiCentre, Inc

Practice address

535 S Pine St
Spokane, WA 99202-1347

Phone

(509) 623-2160

Fax

(509) 623-1135

NPI assigned

Nov 27, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Sandra Conner

Title

Revenue Cycle Manager

Phone

(509) 321-4110

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Plastic SurgiCentre, Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Listed as

Plastic Surgicentre IncCCN 50C0001041

Medicare certification status

ActiveFrom the Provider of Services file

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 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derek Ryan Fletcher, M.D.

  • Plastic Surgery Physician
  • Spokane, WA
  • NPI 1427204098
  Medicare reassignment NPD
• Janelle Dubbins Sousa, MD

  • Plastic and Reconstructive Surgery Physician
  • Spokane, WA
  • NPI 1548402308
  Medicare reassignment NPD
• Hunter Oliver-Allen

  • Plastic Surgery Physician
  • San Francisco, CA
  • NPI 1255759320

  WA

  Medicare reassignment NPD
• Shana Colt

  • Physician Assistant
  • Spokane, WA
  • NPI 1760804785
  Medicare reassignment
• Brittney Knudson, PA

  • Physician Assistant
  • Spokane, WA
  • NPI 1447657812
  Medicare reassignment
• Cameron Darius Clement, PA-C

  • Physician Assistant
  • Fort Sam Houston, TX
  • NPI 1023038916

  WA

  Medicare reassignment
• Christopher John Pannucci, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Spokane, WA
  • NPI 1083737738
  NPD (past)
• Chad Kennedy Wheeler, MD

  • Surgery Physician
  • Spokane, WA
  • NPI 1932210580
  NPD (past)
• Emily Annwyllyd Williams, MD

  • Surgery Physician
  • Spokane, WA
  • NPI 1386755957
  NPD (past)

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1083780662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 PINE ST S",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021347",
            "telephone_number": "509-623-2160",
            "fax_number": "509-623-1135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 S PINE ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021347",
            "telephone_number": "509-623-2160",
            "fax_number": "509-623-1135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGICENTRE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "CONNER",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "509-321-4110",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "L0712575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7059363",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Plastic SurgiCentre, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Plannned Parenthood of the Inland NW
• Plaster & Lemone PLLC
• Plaster and McKennon, PS
• Corey Lee Plaster, DDS
• Plastic Surgery Northwest PLLC
• David A Platt, PHARMD
• Julia Anne Platt, ARNP
• Tara Mae Platt, AAC, CNA
• Nicholas Plaut
• Stephanie Renee Pleiman, N.D.

• Ambulatory Surgical Clinic/Center in Spokane, WA
• Providers in Spokane, WA by specialty
• Ambulatory Surgical Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.