Reconstructive Surgery Center of Newport Beach Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

3506862 Issued in CA

Legal business name

RECONSTRUCTIVE SURGERY CENTER OF NEWPORT BEACH INC

Practice address

180 Newport Center Dr
Suite 150
Newport Beach, CA 92660-6972

Phone

(949) 200-1600

Fax

(949) 200-1610

NPI assigned

Apr 11, 2013

Organization subpart

No

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

Authorized official

Name

Simon J Madorsky, M.DNPI 1447259981

Title

Medical Director

Phone

(949) 200-1600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Reconstructive Surgery Center of Newport Beach IncCCN 05C0002065

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

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

• Simon Joseph Madorsky, M.D.

  • Otolaryngology Physician
  • Newport Beach, CA
  • NPI 1447259981
  NPD (past) Authorized official
• Douglas A Munro, M.D.

  • Diagnostic Radiology Physician
  • Santa Rosa, CA
  • NPI 1205862554
  NPD (past)
• Rama Krishna Yelisetty, DMD

  • Dentist
  • Columbia, SC
  • NPI 1437592516
  NPD (past)

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1437592169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 NEWPORT CENTER DR",
            "address_2": "SUITE 150",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926606972",
            "telephone_number": "949-200-1600",
            "fax_number": "949-200-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 NEWPORT CENTER DR",
            "address_2": "SUITE 150",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926606972",
            "telephone_number": "949-200-1600",
            "fax_number": "949-200-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RECONSTRUCTIVE SURGERY CENTER OF NEWPORT BEACH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "MADORSKY",
        "authorized_official_first_name": "SIMON",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "949-200-1600",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "3506862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• RC Arts Inc (Ruben Castro MD)
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• Paul Francis Reardon, M.D.
• Armando Espino Rebollar
• Hui Sophia Reccow, MA, LMFT
• Recovery Health Options, Inc.
• Redeemed Mental Health LLC (Redeemed Mental Health)
• Samantha Redington, ACSW
• Marissa Jean Redondo
• Reecess Medical Group, Inc.

• Ambulatory Surgical Clinic/Center in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (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.