The Plastic Surgery Group,PC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

38782 Issued in TN

Legal business name

THE PLASTIC SURGERY GROUP,PC

Practice address

1949 Gunbarrel Rd Ste 303
Chattanooga, TN 37421-3188

Phone

(423) 756-7134

Fax

(423) 763-4571

NPI assigned

Mar 20, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Bettye J Chastain

Title

Supervisor

Phone

(423) 763-4543

Specialties & licenses 8

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• The Plastic Surgery Group, P.C.

  • Plastic and Reconstructive Surgery Physician
  • Chattanooga, TN
  • NPI 1356302723

  O20040115000379

  Same enrollment

Practitioners 4

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

• Fernando E Domingo, M.D.

  • Plastic Surgery Physician
  • Chattanooga, TN
  • NPI 1801154935
  NPD
• David Marshall Jemison, MD

  • Orthopaedic Hand Surgery Physician
  • Chattanooga, TN
  • NPI 1922075001
  NPD
• Jimmy Lee Waldrop Jr., MD

  • Plastic and Reconstructive Surgery Physician
  • Chattanooga, TN
  • NPI 1346361433
  NPD
• Eric William Spreeman, OTR, CHT

  • Hand Occupational Therapist
  • Bluffton, SC
  • NPI 1073569588
  NPD

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1669976213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 RIVERFRONT PARKWAY",
            "address_2": "STE 100",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374022102",
            "telephone_number": "423-756-7134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1949 GUNBARREL RD STE 303",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374213188",
            "telephone_number": "423-756-7134",
            "fax_number": "423-763-4571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PLASTIC SURGERY GROUP,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-20",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "CHASTAIN",
        "authorized_official_first_name": "BETTYE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "423-763-4543",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "TN",
            "license": "55433",
            "primary": false
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgery of the Hand",
            "state": "TN",
            "license": "26787",
            "primary": false
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgery of the Hand",
            "state": "TN",
            "license": "28796",
            "primary": false
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgery of the Hand",
            "state": "TN",
            "license": "36502",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TN",
            "license": "38782",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TN",
            "license": "28796",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TN",
            "license": "55433",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TN",
            "license": "36502",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2006636",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CL7313",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Plastic and Reconstructive Surgery Physician in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Plastic and Reconstructive Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; 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.