NPIMap

Organization Active NPI

Petrungaro Plastic Surgery, LLC

  • Plastic and Reconstructive Surgery Physician
  • Munster, IN
National Provider Identifier
1639577794
Registry record updated May 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
01074460A Issued in IN
Legal business name
PETRUNGARO PLASTIC SURGERY, LLC
Practice address
800 Macarthur Blvd Ste 21
Munster, IN 46321-2918
Phone
(219) 836-1163
NPI assigned
Dec 5, 2014
Last updated
May 8, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2015

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

Authorized official

Name
Dr. Jason M Petrungaro, MDNPI 1871765057
Title
President
Phone
(219) 836-1163

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 01074460A IN Primary

Addresses

Primary practice location

800 Macarthur Blvd Ste 21
Munster, IN 46321-2918

Mailing address

800 Macarthur Blvd Ste 21
Munster, IN 46321-2918
Phone (219) 836-1163

Other identifiers 3

IdentifierTypeStateIssuer
5410211OtherINCIGNA
914915OtherINBCBS
9183790OtherINAETNA

National Provider Directory

National Provider Directory

Locations

800 MacArthur Blvd
Ste 21
Munster, IN 46321
Phone (219) 836-1163

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1417737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431043200000",
    "number": "1639577794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MACARTHUR BLVD STE 21",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212918",
            "telephone_number": "219-836-1163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MACARTHUR BLVD STE 21",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212918",
            "telephone_number": "219-836-1163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRUNGARO PLASTIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-05",
        "last_updated": "2015-05-08",
        "status": "A",
        "authorized_official_last_name": "PETRUNGARO",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-836-1163",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IN",
            "license": "01074460A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5410211",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "914915",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9183790",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; 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.