Michael P. Carlisle, M.D. – Plastic Surgery Physician

Key facts

NPI: 1295950376
Entity type: Individual (NPI type 1)
Primary specialty: Plastic Surgery Physician 208200000X
License: MD-42630 (IA)
Practice address: 4855 Mills Civic Pkwy.
Ste. 100
West Des Moines, IA 50265
Phone: (515) 277-5555
Fax: (515) 277-0060
NPI assigned: Apr 16, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Koch Facial Plastic Surgery PC Otolaryngology Physician · West Des Moines, IA · NPI 1316389653

Medicare reassignment Care Compare group NPD IA · OTOLARYNGOLOGY

Medicare Care Compare profile

Specialty: Plastic and Reconstructive Surgery
Also: Otolaryngology
Education: Wayne State University School of Medicine, 2007
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Koch Facial Plastic Surgery PC (2 clinicians)

Practice addresses (Care Compare)

4855 Mills Civic Pkwy
Suite 100
West Des Moines, IA 50265-5280
Phone (515) 277-5555

Procedures performed for Medicare patients

Procedure	Number of procedures
Mastectomy	1-10
Melanoma (skin cancer) excision	44

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20150806011060	IA	Practitioner - Plastic and Reconstructive Surgery Practitioner - Otolaryngology	8123344108	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
PENDING	KS	MD	Physician Assistant

Practice roles

Organization	Specialty	Status	New patients
Koch Facial Plastic Surgery PC	Otolaryngology	Current since Feb 1, 2022	Accepting new patients

Locations

4855 Mills Civic Pkwy
Ste 100
West Des Moines, IA 50265
Phone (515) 242-8000

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Specialist	174400000X	PENDING	KS
Otolaryngology Physician	207Y00000X	MD-42630	IA
Plastic Surgery Physician	208200000X	MD-42630	IA	Yes

Addresses

Primary practice location

4855 Mills Civic Pkwy.
Ste. 100
West Des Moines, IA 50265

Mailing address

4855 Mills Civic Pkwy.
Ste. 100
West Des Moines, IA 50265
Phone (515) 277-5555

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 30, 2023.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1295950376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 MILLS CIVIC PKWY.",
            "address_2": "STE. 100",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "50265",
            "telephone_number": "515-277-5555",
            "fax_number": "515-277-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 MILLS CIVIC PKWY.",
            "address_2": "STE. 100",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "50265",
            "telephone_number": "515-277-5555",
            "fax_number": "515-277-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLISLE",
        "first_name": "MICHAEL",
        "middle_name": "P.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "KS",
            "license": "PENDING",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IA",
            "license": "MD-42630",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IA",
            "license": "MD-42630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Des Moines, IA

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Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.