NPIMap

Organization Active NPI

Joseph Advanced Facial Plastic Surgery, PLLC

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Troy, MI
National Provider Identifier
1154082428
Registry record updated Jul 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X
Legal business name
JOSEPH ADVANCED FACIAL PLASTIC SURGERY, PLLC
Practice address
3940 John R Rd
Troy, MI 48083-5688
Phone
(947) 217-3223
NPI assigned
Jan 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2024

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

Authorized official

Name
Dr. Shannon S. Joseph, MDNPI 1396060224
Title
Member
Phone
(947) 217-3223

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmic Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207WX0200X Primary
Facial Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YS0123X

Addresses

Primary practice location

3940 John R Rd
Troy, MI 48083-5688

Mailing address

3435 Livernois Rd
Troy, MI 48083-5063
Phone (947) 217-3223

Other practice location 1

3435 Livernois Rd
Troy, MI 48083-5063
Phone (947) 217-3223

Other names 1

  • JOSEPH Advanced Oculofacial Plastic Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220512001580 MI Part B Supplier - Clinic/Group Practice 3870970866 Receives reassigned benefits from 2 practitioners
Practice locations: Troy, MI

National Provider Directory

National Provider Directory

Locations

3435 Livernois Rd
Troy, MI 48083
Phone (248) 743-1234

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720310400000",
    "number": "1154082428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3435 LIVERNOIS RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480835063",
            "telephone_number": "947-217-3223",
            "fax_number": "248-817-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3940 JOHN R RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480835688",
            "telephone_number": "947-217-3223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3435 Livernois Rd",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480835063",
            "country_code": "US",
            "telephone_number": "947-217-3223",
            "fax_number": "248-817-3994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JOSEPH ADVANCED FACIAL PLASTIC SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-07",
        "last_updated": "2024-07-07",
        "certification_date": "2024-07-07",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "947-217-3223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207WX0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JOSEPH Advanced Oculofacial Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.