Advanced Plastic Surgery Center, L.L.C.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ADVANCED PLASTIC SURGERY CENTER, L.L.C.

Practice address

1615 Petroglyph Point Dr
Prescott, AZ 86301-6539

Phone

(928) 777-0200

Fax

(928) 443-1117

NPI assigned

Jul 10, 2007

Last updated

Aug 16, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mark D Fetter, M.D.NPI 1568427490

Title

Medical Director

Phone

(928) 777-0200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Listed as

Advanced Plastic Surgery Center LLCCCN 03C0001306

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 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark Fetter, M.D.

  • Specialist
  • Prescott, AZ
  • NPI 1568427490
  Authorized official Same address or phone

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1447458591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 PETROGLYPH POINT DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863016539",
            "telephone_number": "928-777-0200",
            "fax_number": "928-443-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 PETROGLYPH POINT DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863016539",
            "telephone_number": "928-777-0200",
            "fax_number": "928-443-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PLASTIC SURGERY CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "FETTER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "928-777-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; 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.