The Center for Plastic Surgery of Northern Michigan

Primary specialty

SpecialistTaxonomy code 174400000X

License

4301054838 Issued in MI

Legal business name

THE CENTER FOR PLASTIC SURGERY OF NORTHERN MICHIGAN

Practice address

4110 Copper Ridge Dr
Suite 242
Traverse City, MI 49684-6722

Phone

(231) 929-7700

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Christopher JeffriesNPI 1306003819

Title

Owner

Phone

(231) 929-7700

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 2

• Steven V Thomas MD and Associates PC Doing business as
• The Center for Plastic Surgery at Copper Ridge Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

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

• Christopher Carson Jeffries, M.D.

  • Plastic Surgery Physician
  • Traverse City, MI
  • NPI 1306003819
  Medicare reassignment Care Compare group Authorized official
• Breena Marie Johnson, PA-C

  • Surgical Physician Assistant
  • Petoskey, MI
  • NPI 1982908075
  Medicare reassignment Care Compare group
• Ryan Scot Burke, MD

  • Plastic Surgery Physician
  • Traverse City, MI
  • NPI 1639566094
  Medicare reassignment

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620864000000",
    "number": "1356563654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 COPPER RIDGE DR",
            "address_2": "SUITE 242",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846722",
            "telephone_number": "231-929-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 COPPER RIDGE DR",
            "address_2": "SUITE 242",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846722",
            "telephone_number": "231-929-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR PLASTIC SURGERY OF NORTHERN MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "JEFFRIES",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-929-7700"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301054838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2402810801",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4859055",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "2402810801",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Steven V Thomas MD and Associates PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Center for Plastic Surgery at Copper Ridge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Center for Plastic Surgery at Copper Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; 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.