Organization Active NPI

Signature Plastic & Reconstructive Surgery, PLLC

  • Plastic Surgery Physician
  • Charlotte, NC
National Provider Identifier
1508394990
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
SIGNATURE PLASTIC & RECONSTRUCTIVE SURGERY, PLLC
Practice address
13545 Steelecroft Pkwy Ste 110
Charlotte, NC 28278-7562
Phone
(352) 514-1524
NPI assigned
May 30, 2017
Organization subpart
Yes
Parent organization
-As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

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

Authorized official

Name
Melissa Marks, D.O.NPI 1518278175
Title
Manager
Phone
(352) 514-1524

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X OS14397 FL
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

13545 Steelecroft Pkwy Ste 110
Charlotte, NC 28278-7562

Mailing address

13545 Steelecroft Pkwy Ste 110
Charlotte, NC 28278-7562
Phone (352) 514-1524

Other practice location 1

3345 Burns Rd Ste 101
Palm Beach Gardens, FL 33410-4304
Phone (561) 775-1212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230206002243 NC Part B Supplier - Clinic/Group Practice 8325385297 Receives reassigned benefits from 1 practitioner
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory
Part of
Signature Plastic Recon

Locations

13545 Steelecroft Pkwy
Ste 110
Charlotte, NC 28278
Phone (352) 514-1524

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1496102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1508394990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13545 STEELECROFT PKWY STE 110",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282787562",
            "telephone_number": "352-514-1524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13545 STEELECROFT PKWY STE 110",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282787562",
            "telephone_number": "352-514-1524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3345 Burns Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Palm Beach Gardens",
            "state": "FL",
            "postal_code": "334104304",
            "country_code": "US",
            "telephone_number": "561-775-1212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SIGNATURE PLASTIC & RECONSTRUCTIVE SURGERY, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "-",
        "enumeration_date": "2017-05-30",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "MARKS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "352-514-1524",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "FL",
            "license": "OS14397",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; 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.