NPIMap

Organization Active NPI

Main Line Institute of Plastic Surgery Inc

  • Plastic Surgery Physician
  • Wynnewood, PA
National Provider Identifier
1699016147
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
MD422651 Issued in PA
Legal business name
MAIN LINE INSTITUTE OF PLASTIC SURGERY INC
Practice address
100 E Lancaster Ave
Mobe #660
Wynnewood, PA 19096-3450
Phone
(610) 896-6666
Fax
(610) 896-6669
NPI assigned
Mar 8, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

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

Authorized official

Name
Dr. Ryan Samuel Hoffman, M.D.NPI 1861696320
Title
Provider
Phone
(610) 896-6666

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X MD422651 PA Primary

Addresses

Primary practice location

100 E Lancaster Ave
Mobe #660
Wynnewood, PA 19096-3450

Mailing address

100 E Lancaster Ave
Mobe #660
Wynnewood, PA 19096-3450
Phone (610) 896-6666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130604000044 PA Part B Supplier - Clinic/Group Practice 2062650054 Receives reassigned benefits from 2 practitioners
Practice locations: Wynnewood, PA

National Provider Directory

National Provider Directory

Locations

775 E Lancaster Ave
Ste 230
Villanova, PA 19085
Phone (610) 896-6666

100 E Lancaster Ave
#660
Wynnewood, PA 19096
Phone (610) 896-6666

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JEGCCA

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1362700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1699016147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE",
            "address_2": "MOBE #660",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963450",
            "telephone_number": "610-896-6666",
            "fax_number": "610-896-6669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE",
            "address_2": "MOBE #660",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963450",
            "telephone_number": "610-896-6666",
            "fax_number": "610-896-6669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN LINE INSTITUTE OF PLASTIC SURGERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-08",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "SAMUEL",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "610-896-6666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "PA",
            "license": "MD422651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynnewood, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; 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.