Organization Active NPI

Plastic Surgery Consultants, LLC

  • Specialist
  • Columbia, SC
National Provider Identifier
1245319094
Registry record updated Oct 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
19438 Issued in SC
Legal business name
PLASTIC SURGERY CONSULTANTS, LLC
Practice address
1220 Blanding St
Columbia, SC 29201-2816
Phone
(803) 779-1200
Fax
(803) 779-1220
NPI assigned
Nov 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2011

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

Authorized official

Name
Dr. Richard J Wassermann, M.D., MPH, FACSNPI 1336191931
Title
Medical Director
Phone
(803) 779-1200

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 19438 SC Primary

Addresses

Primary practice location

1220 Blanding St
Columbia, SC 29201-2816

Mailing address

1220 Blanding St
Columbia, SC 29201-2816
Phone (803) 779-1200

Other identifiers 1

IdentifierTypeStateIssuer
GP3494MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041011000527 SC Part B Supplier - Clinic/Group Practice 6507826906 Receives reassigned benefits from 3 practitioners
Practice locations: Columbia, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318377600000",
    "number": "1245319094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 BLANDING ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012816",
            "telephone_number": "803-779-1200",
            "fax_number": "803-779-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 BLANDING ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012816",
            "telephone_number": "803-779-1200",
            "fax_number": "803-779-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGERY CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2011-10-12",
        "status": "A",
        "authorized_official_last_name": "WASSERMANN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "803-779-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., MPH, FACS"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "SC",
            "license": "19438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3494",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; 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.