NPIMap

Organization Active NPI

Advanced Surgical and Restorative Care LLC

  • Ambulatory Surgical Clinic/Center
  • Altoona, WI
National Provider Identifier
1194466235
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
ADVANCED SURGICAL AND RESTORATIVE CARE LLC
Doing business as
Defatta ENT & Plastics Surgery, SC
Practice address
1470 Rivers Edge TRL Ste B
Altoona, WI 54720-2755
Phone
(715) 379-8718
NPI assigned
Apr 5, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Emily Moses
Title
Chief Nursing Officer
Phone
(715) 930-1937

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1470 Rivers Edge TRL Ste B
Altoona, WI 54720-2755

Mailing address

1470 Rivers Edge TRL Ste B
Altoona, WI 54720-2755

Other names 1

  • Defatta ENT & Plastics Surgery, SC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220822001815 WI Part B Supplier - Ambulatory Surgical Center 0143603357 Receives reassigned benefits from 9 practitioners
Practice locations: Altoona, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Advanced Surgical and Restorative Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1194466235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1470 RIVERS EDGE TRL STE B",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "547202755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1470 RIVERS EDGE TRL STE B",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "547202755",
            "telephone_number": "715-379-8718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SURGICAL AND RESTORATIVE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2025-09-02",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "MOSES",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "CHIEF NURSING OFFICER",
        "authorized_official_telephone_number": "715-930-1937"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Defatta ENT & Plastics Surgery, SC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Altoona, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.