Plastic Surgery Center of St Joseph, Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

136-0 Issued in MO

Legal business name

PLASTIC SURGERY CENTER OF ST JOSEPH, INC

Practice address

2111 N Woodbine Rd
Saint Joseph, MO 64506-2440

Phone

(816) 364-6416

Fax

(816) 364-5320

NPI assigned

Jun 22, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Michael D De Priest, MDNPI 1639175029

Title

Medical Director

Phone

(816) 364-6446

Specialties & licenses 1

Addresses

Other identifiers 2

Listed as

Plastic Surgery Center of St Joseph IncCCN 26C0001081

Medicare certification status

Terminated Voluntary: merger or closure, Jun 30, 2025From the Provider of Services file

Practitioners 1

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

• Michael D De Priest, MD

  • Surgery of the Hand (Plastic Surgery) Physician
  • Saint Joseph, MO
  • NPI 1639175029
  NPD Authorized official

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419984000000",
    "number": "1508862996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 N WOODBINE RD",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062440",
            "telephone_number": "816-364-6416",
            "fax_number": "816-364-5320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 N WOODBINE RD",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062440",
            "telephone_number": "816-364-6416",
            "fax_number": "816-364-5320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGERY CENTER OF ST JOSEPH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2014-12-31",
        "status": "A",
        "authorized_official_last_name": "DE PRIEST",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "816-364-6446",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "136-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "136-0",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "509336905",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Tara Ploeger, COTA
• Melissa Plum, DC
• Barbara Ann Poage, RPT
• Brenda L. Polachek, FNP-BC
• Chester Pontius

• Ambulatory Surgical Clinic/Center in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.