Portland Plastic Surgery Group, LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

PORTLAND PLASTIC SURGERY GROUP, LLC

Practice address

1200 NW Naito Pkwy Ste 310
Portland, OR 97209-2829

Phone

(503) 292-9200

Fax

(503) 292-9205

NPI assigned

Feb 14, 2014

Organization subpart

No

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

Authorized official

Name

Billi Jo Nowka

Title

Office Manager

Phone

(503) 928-3001

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 6

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

• Kyle Matthew Baltrusch, MD

  • Plastic and Reconstructive Surgery Physician
  • Portland, OR
  • NPI 1952741779
  Medicare reassignment Care Compare group NPD
• Shannon Parker O'Brien, M.D.

  • Plastic Surgery Physician
  • Portland, OR
  • NPI 1730380999
  Medicare reassignment Care Compare group NPD
• Geneva Ann Eagon, PA

  • Physician Assistant
  • Portland, OR
  • NPI 1114533072
  Medicare reassignment Care Compare group
• Colleen D Phillips, PA-C

  • Surgical Physician Assistant
  • Portland, OR
  • NPI 1245308618
  Medicare reassignment Care Compare group
• Henry Daniel Zegzula, M.D.

  • Plastic Surgery Physician
  • Portland, OR
  • NPI 1811968639
  Medicare reassignment Care Compare group
• Austin George Hayes, MD

  • Plastic and Reconstructive Surgery Physician
  • Hillsboro, OR
  • NPI 1376733212
  Medicare reassignment NPD

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

{
    "created_epoch": "1392336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1437573185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NW NAITO PKWY STE 310",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092829",
            "telephone_number": "503-292-9200",
            "fax_number": "503-292-9205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NW NAITO PKWY STE 310",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092829",
            "telephone_number": "503-292-9200",
            "fax_number": "503-292-9205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND PLASTIC SURGERY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-14",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "NOWKA",
        "authorized_official_first_name": "BILLI",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-928-3001"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portland Pediatric Acupuncture
• Portland Pediatric Nutrition
• Portland Pediatric Psychology, LLC
• Portland Peritoneal Center, Inc.
• Portland Physical Therapy
• Portland Preventive Cardiology LLC
• Portland Pro Health Therapies, PC
• Portland Professional Pharmacy, LLC
• Portland PS Early Childhood
• Portland PS Pioneer Program

• Plastic Surgery Physician in Portland, OR
• Providers in Portland, OR by specialty
• Plastic Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; 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.