Michael Robert Davis, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

01053296A Issued in IN

Practice address

7900 W Jefferson Blvd Ste 306
Fort Wayne, IN 46804-4128

Phone

(260) 458-3610

Fax

(260) 458-3611

NPI assigned

Nov 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in PA, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Plastic and Reconstructive Surgery

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Texas Aesthetic and Reconstructive Surgery PLLCGroup PAC ID 5890078703, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• South Texas Aesthetic and Reconstructive Surgery PLLC

  • Plastic and Reconstructive Surgery Physician
  • San Antonio, TX
  • NPI 1285042556
  Medicare reassignment Care Compare group NPD
• DLP Conemaugh Physician Practices LLC

  • Family Medicine Physician
  • Cresson, PA
  • NPI 1932515905
  Medicare reassignment NPD
• DLP Conemaugh Physician Practices LLC

  • Internal Medicine Physician
  • Johnstown, PA
  • NPI 1205242609
  NPD
• DLP Conemaugh Physician Practices LLC

  • Family Medicine Physician
  • Johnstown, PA
  • NPI 1861808909
  NPD

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524096000000",
    "number": "1477622934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3514",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 W JEFFERSON BLVD STE 306",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044128",
            "telephone_number": "260-458-3610",
            "fax_number": "260-458-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MICHAEL",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2018-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "AL",
            "license": "26620",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "P1857",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IN",
            "license": "01053296A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009941892",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051540216",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009941891",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009942208",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051540217",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051540215",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linde Davis
• Lyndi Davis, NP
• Megan Noelle Davis, RN
• Melinda Davis, LCSW
• Michael J Davis, DO, MPH
• Monchelle Denise Davis
• Noreen L Davis, HIS
• Ruth G. Davis, LCSW
• Scott Davis, M.D.
• Sherwin O Davis, PHARMD

• Plastic Surgery Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Plastic Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.