Bend Plastic & Reconstructive Surgery, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

MD26066 Issued in OR

Legal business name

BEND PLASTIC & RECONSTRUCTIVE SURGERY, LLC

Doing business as

Bend Plastic Surgery

Practice address

1239 NE Medical Center Dr Ste 240
Bend, OR 97701-7359

Phone

(541) 749-2282

Fax

(541) 749-2283

NPI assigned

Jan 2, 2009

Last updated

Mar 19, 2024By 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

Dr. Adam Peter Angeles, MDNPI 1336209345

Title

Medical Director

Phone

(541) 749-2282

Specialties & licenses 1

Addresses

Other names 1

• BEND PLASTIC SURGERY Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 2

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.

• Adam Peter Angeles, MD

  • Plastic and Reconstructive Surgery Physician
  • Bend, OR
  • NPI 1336209345
  Medicare reassignment NPD Authorized official
• Kenneth Adam Conklin, MPAS, PA-C

  • Surgical Physician Assistant
  • Redmond, OR
  • NPI 1669851606
  Medicare reassignment

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

{
    "created_epoch": "1230854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1083850689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1239 NE MEDICAL CENTER DR STE 240",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017359",
            "telephone_number": "541-749-2282",
            "fax_number": "541-749-2283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 NE MEDICAL CENTER DR STE 240",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017359",
            "telephone_number": "541-749-2282",
            "fax_number": "541-749-2283"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "235 S Canyon Blvd",
            "address_purpose": "LOCATION",
            "city": "John Day",
            "state": "OR",
            "postal_code": "978451044",
            "country_code": "US",
            "telephone_number": "541-749-2282",
            "fax_number": "541-749-2283",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "233 S Canyon Blvd",
            "address_purpose": "LOCATION",
            "city": "John Day",
            "state": "OR",
            "postal_code": "978451044",
            "country_code": "US",
            "telephone_number": "541-749-2282",
            "fax_number": "541-749-2283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEND PLASTIC & RECONSTRUCTIVE SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-02",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "ANGELES",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "541-749-2282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "OR",
            "license": "MD26066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BEND PLASTIC SURGERY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Bend Plastic & Reconstructive Surgery, P.C.
• Bend Senior Care Management LLC
• Bend Somatic Counseling LTD.
• Bend Sovereign Wellness LLC (Bend Sovereign Wellness)
• Bend Spine & Pain Specialists, LLC

• Multi-Specialty Clinic/Center in Bend, OR
• Providers in Bend, OR by specialty
• Multi-Specialty Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.