Cosmetic & Reconstructive Surgery Center, PA

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0429556 Issued in KS

Legal business name

COSMETIC & RECONSTRUCTIVE SURGERY CENTER, PA

Practice address

1700 N Waterfront Pkwy
Building 200
Wichita, KS 67206-6614

Phone

(316) 681-2227

Fax

(316) 684-5250

NPI assigned

May 25, 2006

Last updated

Dec 11, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Harris Conrad, M.D.NPI 1700831294

Title

Physician

Phone

(316) 681-2227

Specialties & licenses 1

Addresses

Other names 1

• COSMETIC & RECONSTRUCTIVE SURGERY CENTER Other name

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Listed as

Cosmetic and Reconstructive Surgery Center PACCN 17C0001073

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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.

• Matthew Harris Conrad, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Wichita, KS
  • NPI 1700831294
  NPD Authorized official

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418256000000",
    "number": "1659327245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 N WATERFRONT PKWY",
            "address_2": "BUILDING 200",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672066614",
            "telephone_number": "316-681-2227",
            "fax_number": "316-684-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N WATERFRONT PKWY",
            "address_2": "BUILDING 200",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672066614",
            "telephone_number": "316-681-2227",
            "fax_number": "316-684-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMETIC & RECONSTRUCTIVE SURGERY CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2014-12-11",
        "status": "A",
        "authorized_official_last_name": "CONRAD",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "HARRIS",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "316-681-2227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "KS",
            "license": "0429556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COSMETIC & RECONSTRUCTIVE SURGERY CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Corterra of Wichita, LLC
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• Malisa Cortest
• Cheryl A Cortez, RDN
• Mitchell Corwin
• Simone Cosper, LSCSW
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• Costco Wholesale Corporation (Costco Hearing Aid #1200)
• Johnna Suzanne Costello, FNP-C

• Ambulatory Surgical Clinic/Center in Wichita, KS
• Providers in Wichita, KS by specialty
• Ambulatory Surgical Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.