NPIMap

Organization Active NPI

Hand & Plastic Surgery Centre PLC

Doing business as Elite Plastic Surgery

  • Surgery of the Hand (Surgery) Physician
  • Grand Rapids, MI
National Provider Identifier
1245394576
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery of the Hand (Surgery) PhysicianTaxonomy code 2086S0105X
Legal business name
HAND & PLASTIC SURGERY CENTRE PLC
Doing business as
Elite Plastic Surgery
Practice address
245 Cherry St SE
Suite 302
Grand Rapids, MI 49503-4607
Phone
(616) 459-4131
Fax
(616) 459-6030
NPI assigned
Dec 21, 2006
Last updated
Feb 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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

Authorized official

Name
Kathy Allen-Stouffer
Title
Practice Administrator
Phone
(616) 459-4131

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery of the Hand (Surgery) Physician 2086S0105X MI Primary
Plastic and Reconstructive Surgery Physician 2086S0122X MI

Addresses

Primary practice location

245 Cherry St SE
Suite 302
Grand Rapids, MI 49503-4607

Mailing address

245 Cherry St SE
Suite 302
Grand Rapids, MI 49503-4607
Phone (616) 459-4131

Other identifiers 7

IdentifierTypeStateIssuer
0D16253OtherMIBCBS OF MICHIGAN
3323257MedicaidMI
2727404MedicaidMI
4075832MedicaidMI
4273703MedicaidMI
4488298MedicaidMI
4694901MedicaidMI

Other names 1

  • Elite 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
O20041102001157 MI Part B Supplier - Clinic/Group Practice 0042272940 Receives reassigned benefits from 4 practitioners
Practice locations: Grand Rapids, MI

National Provider Directory

National Provider Directory

Locations

245 Cherry St SE
Ste 302
Grand Rapids, MI 49503
Phone (616) 459-4131

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644796800000",
    "number": "1245394576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 CHERRY ST SE",
            "address_2": "SUITE 302",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034607",
            "telephone_number": "616-459-4131",
            "fax_number": "616-459-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 CHERRY ST SE",
            "address_2": "SUITE 302",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034607",
            "telephone_number": "616-459-4131",
            "fax_number": "616-459-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAND & PLASTIC SURGERY CENTRE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A",
        "authorized_official_last_name": "ALLEN-STOUFFER",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "616-459-4131"
    },
    "taxonomies": [
        {
            "code": "2086S0105X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgery of the Hand",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "0D16253",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3323257",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2727404",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4075832",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4273703",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4488298",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4694901",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elite Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; 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.