NPIMap

Organization Active NPI

Plastic and Peripheral Nerve Surgery LLC

  • Plastic and Reconstructive Surgery Physician
  • Sun Lakes, AZ
National Provider Identifier
1760044325
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
PLASTIC AND PERIPHERAL NERVE SURGERY LLC
Practice address
25229 S Sun Lakes Blvd Ste 101
Sun Lakes, AZ 85248-6465
Phone
(480) 802-8511
Fax
(480) 802-8129
NPI assigned
Jul 3, 2019
Last updated
Jul 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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

Authorized official

Name
Sean Wolfort, MDNPI 1477517712
Title
Member
Phone
(480) 802-8511

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 and Reconstructive Surgery Physician 2086S0122X NU Primary

Addresses

Primary practice location

25229 S Sun Lakes Blvd Ste 101
Sun Lakes, AZ 85248-6465

Mailing address

25229 S Sun Lakes Blvd Ste 101
Sun Lakes, AZ 85248-6465
Phone (480) 802-8511

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191108000213 AZ Part B Supplier - Clinic/Group Practice 9133551310 Receives reassigned benefits from 1 practitioner
Practice locations: Tempe, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1760044325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25229 S SUN LAKES BLVD STE 101",
            "city": "SUN LAKES",
            "state": "AZ",
            "postal_code": "852486465",
            "telephone_number": "480-802-8511",
            "fax_number": "480-802-8129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25229 S SUN LAKES BLVD STE 101",
            "city": "SUN LAKES",
            "state": "AZ",
            "postal_code": "852486465",
            "telephone_number": "480-802-8511",
            "fax_number": "480-802-8129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC AND PERIPHERAL NERVE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-03",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "WOLFORT",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "480-802-8511",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun Lakes, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.