NPIMap

Organization Active NPI

Deperro Plastic Surgery, LLC

  • Plastic Surgery Physician
  • Columbus, OH
National Provider Identifier
1134573496
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
DEPERRO PLASTIC SURGERY, LLC
Practice address
1830 Bethel Rd Ste 200
Columbus, OH 43220-1809
Phone
(614) 429-4950
Fax
(614) 429-4948
NPI assigned
Apr 22, 2016
Last updated
Nov 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Authorized official

Name
Michael Deperro III, M.D.NPI 1255588810
Title
Owner
Phone
(614) 940-6607

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

1830 Bethel Rd Ste 200
Columbus, OH 43220-1809

Mailing address

1830 Bethel Rd Ste 200
Columbus, OH 43220-1809
Phone (614) 429-4950

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160725000453 OH Part B Supplier - Clinic/Group Practice 4284927542 Receives reassigned benefits from 1 practitioner
Practice locations: Columbus, OH; Dublin, OH

National Provider Directory

National Provider Directory

Locations

5151 Reed Rd
Ste 225C
Columbus, OH 43220
Phone (614) 457-2306

793 W State St
Columbus, OH 43222
Phone (614) 234-1862

Practitioners & affiliated clinicians

Practitioners 262

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.

View all 262

NPI Registry JSON

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

{
    "created_epoch": "1461283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1134573496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 BETHEL RD STE 200",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432201809",
            "telephone_number": "614-429-4950",
            "fax_number": "614-429-4948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 BETHEL RD STE 200",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432201809",
            "telephone_number": "614-429-4950",
            "fax_number": "614-429-4948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPERRO PLASTIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-22",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "DEPERRO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "614-940-6607",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; 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.