Summit Plastic Surgery, PC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

SUMMIT PLASTIC SURGERY, PC

Practice address

7920 W Jefferson Blvd Ste 200
Fort Wayne, IN 46804-4166

Phone

(260) 490-7111

Fax

(260) 490-2286

NPI assigned

Dec 16, 2005

Organization subpart

No

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

Authorized official

Name

Kathy Fiechter

Title

Practice Administrator

Phone

(260) 490-7111

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Dupont Hospital LLC

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1538110556

  Member Of

  NPD member

Locations

Practitioners 6

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

• Matthew E Shambaugh, MD

  • Plastic Surgery Physician
  • Fort Wayne, IN
  • NPI 1700888617
  Medicare reassignment NPD
• Darlene K Hoover, PA-C

  • Physician Assistant
  • Fort Wayne, IN
  • NPI 1184625527
  NPD (past)
• Brian J Lee, MD

  • Plastic Surgery Physician
  • Fort Wayne, IN
  • NPI 1508867656
  NPD (past)
• Joseph M Mlakar, MD

  • Plastic Surgery Physician
  • Fort Wayne, IN
  • NPI 1801897244
  NPD (past)
• Geoffrey M Randolph, MD

  • Plastic Surgery Physician
  • Fort Wayne, IN
  • NPI 1194726380
  NPD (past)
• John S Mancoll, MD

  • Plastic Surgery Physician
  • Virginia Beach, VA
  • NPI 1992706337
  NPD (past)

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1194701664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7920 W JEFFERSON BLVD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044166",
            "telephone_number": "260-490-7111",
            "fax_number": "260-490-2286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7920 W JEFFERSON BLVD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044166",
            "telephone_number": "260-490-7111",
            "fax_number": "260-490-2286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT PLASTIC SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "FIECHTER",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "260-490-7111"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2289394",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200375290A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Summit Hearing Solutions,Inc.
• Summit Medical Associates LLC
• Summit Nutrition Services, LLC
• Summit Orthodontics, PC
• Summit Physical Therapy LLC
• Summit Psychiatric Services LLC
• Summit Radiology P C
• Summit Retina Consultants, P.C.
• Summit Speech & Language Care Inc
• Summit Spine & Sports Medicine, PC

• Plastic Surgery Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Plastic Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; 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.