NPIMap

Organization Active NPI

MP Plastic Surgery PLLC

  • Plastic Surgery Physician
  • Fort Worth, TX
National Provider Identifier
1275922734
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
P5223 Issued in TX
Legal business name
MP PLASTIC SURGERY PLLC
Practice address
800 8TH Ave Ste 206
Fort Worth, TX 76104-2619
Phone
(817) 529-9199
Fax
(817) 334-0491
NPI assigned
Jan 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Authorized official

Name
Mr. Maxim Pekarev, M.D.NPI 1851618649
Title
Physician/Owner
Phone
(817) 529-9199

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
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X P5223 TX Primary

Addresses

Primary practice location

800 8TH Ave Ste 206
Fort Worth, TX 76104-2619

Mailing address

800 8TH Ave Ste 206
Fort Worth, TX 76104-2619
Phone (817) 529-9199

Other identifiers 1

IdentifierTypeStateIssuer
328016601MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180831000013 TX Part B Supplier - Clinic/Group Practice 1254681844 Receives reassigned benefits from 9 practitioners
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1421798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1275922734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 8TH AVE STE 206",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042619",
            "telephone_number": "817-529-9199",
            "fax_number": "817-334-0491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 8TH AVE STE 206",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042619",
            "telephone_number": "817-529-9199",
            "fax_number": "817-334-0491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MP PLASTIC SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-21",
        "last_updated": "2023-10-11",
        "certification_date": "2021-08-28",
        "status": "A",
        "authorized_official_last_name": "PEKAREV",
        "authorized_official_first_name": "MAXIM",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "817-529-9199",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "P5223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "328016601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.