Form MD Plastic Surgery

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

Legal business name

FORM MD PLASTIC SURGERY

Practice address

26691 Plaza Ste 200
Mission Viejo, CA 92691-8582

Phone

(949) 998-2020

NPI assigned

Jan 29, 2020

Organization subpart

No

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

Authorized official

Name

Taylor R Pollei, MDNPI 1366676942

Title

Ceo/Provider

Phone

(949) 998-2020

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

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

• Taylor R Pollei, M.D.

  • Facial Plastic Surgery Physician
  • Mission Viejo, CA
  • NPI 1366676942
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1164053104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26691 PLAZA STE 200",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918582",
            "telephone_number": "949-998-2020",
            "fax_number": "949-998-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26691 PLAZA STE 200",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918582",
            "telephone_number": "949-998-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM MD PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-29",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "POLLEI",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO/PROVIDER",
        "authorized_official_telephone_number": "949-998-2020",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology/Facial Plastic Surgery Physician in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Otolaryngology/Facial Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; 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.