NPIMap

Organization Active NPI

Southwest Virginia Center for Cosmetic Plastic & Recon Surgery

  • Plastic Surgery Physician
  • Roanoke, VA
National Provider Identifier
1609958776
Registry record updated Apr 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
0101050226 Issued in VA
Legal business name
SOUTHWEST VIRGINIA CENTER FOR COSMETIC PLASTIC & RECON SURGERY
Practice address
2965 Colonnade Drive
Suite 140
Roanoke, VA 24018-3541
Phone
(540) 989-6361
Fax
(540) 989-6361
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2011

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

Authorized official

Name
Dr. Michael J Breiner, M.D.
Title
President
Phone
(540) 989-6361

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 0101050226 VA
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X 0101050226 VA Primary

Addresses

Primary practice location

2965 Colonnade Drive
Suite 140
Roanoke, VA 24018-3541

Mailing address

2965 Colonnade Drive
Suite 140
Roanoke, VA 24018-3541
Phone (540) 989-6361

Other identifiers 7

IdentifierTypeStateIssuer
323954OtherANTHEM
089951000OtherQUAL CHOICE
240000224OtherUNITED HEALTHCARE
76991OtherSOUTHERN HEALTH
06901051MedicaidVA
348227OtherMAMSI
AETNAOther4420846

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1609958776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 COLONNADE DRIVE",
            "address_2": "SUITE 140",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240183541",
            "telephone_number": "540-989-6361",
            "fax_number": "540-989-8697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2965 COLONNADE DRIVE",
            "address_2": "SUITE 140",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240183541",
            "telephone_number": "540-989-6361",
            "fax_number": "540-989-6361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST VIRGINIA CENTER FOR COSMETIC PLASTIC & RECON SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "BREINER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-989-6361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101050226",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "VA",
            "license": "0101050226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "323954",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUAL CHOICE",
            "identifier": "089951000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "240000224",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "76991",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06901051",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "348227",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "4420846",
            "identifier": "AETNA",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.