NPIMap

Organization Active NPI

Plastic Surgical Center of Rapid City, Prof. L.L.C.

  • Ambulatory Surgical Clinic/Center
  • Rapid City, SD
National Provider Identifier
1760465207
Registry record updated Apr 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
11152 Issued in SD
Legal business name
PLASTIC SURGICAL CENTER OF RAPID CITY, PROF. L.L.C.
Practice address
3615 5TH St
Suite 100
Rapid City, SD 57701-6014
Phone
(605) 343-6714
Fax
(605) 343-2130
NPI assigned
Nov 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2013

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

Authorized official

Name
Dr. Robert James Schutz, M.D.NPI 1477683324
Title
MD/Medical Director
Phone
(605) 343-6714

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
Ambulatory Surgical Clinic/Center 261QA1903X 11152 SD Primary

Addresses

Primary practice location

3615 5TH St
Suite 100
Rapid City, SD 57701-6014

Mailing address

3615 5TH St
Suite 100
Rapid City, SD 57701-6014
Phone (605) 343-6714

Other identifiers 1

IdentifierTypeStateIssuer
81014OtherSDWELLMARK BCBS #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081015000028 SD Part B Supplier - Ambulatory Surgical Center 3577621879 Practice locations: Rapid City, SD

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Plastic Surgical Center of Rapid City Prof LLCCCN 43C0001026
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
43D1045358Plastic Surgical Center3615 5TH Street Suite 100, Rapid City, SD 57701Certificate of waiverSep 12, 2027

National Provider Directory

National Provider Directory

Locations

3615 5th St
Ste 101
Rapid City, SD 57701
Phone (605) 343-6714

3615 5th St
Rapid City, SD 57701
Phone (605) 341-4470

Practitioners & affiliated clinicians

Practitioners 6

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": "1133222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367280000000",
    "number": "1760465207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 5TH ST",
            "address_2": "SUITE 100",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577016014",
            "telephone_number": "605-343-6714",
            "fax_number": "605-343-2130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 5TH ST",
            "address_2": "SUITE 100",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577016014",
            "telephone_number": "605-343-6714",
            "fax_number": "605-343-2130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGICAL CENTER OF RAPID CITY, PROF. L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-29",
        "last_updated": "2013-04-30",
        "status": "A",
        "authorized_official_last_name": "SCHUTZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "MD/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "605-343-6714",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "SD",
            "license": "11152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS #",
            "identifier": "81014",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2013; 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.