Grand Rapids Plastic Surgery PLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

GRAND RAPIDS PLASTIC SURGERY PLC

Doing business as

Centre for Plastic Surgery

Practice address

2060 East Paris Ave SE
Suite 150
Grand Rapids, MI 49546

Phone

(616) 454-1256

Fax

(616) 454-0308

NPI assigned

Apr 1, 2008

Last updated

Jul 31, 2013By 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

Ms. Carol Jean Fewless

Title

Practice Administrator

Phone

(616) 454-1256

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Centre for Plastic Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Rebecca Boston, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Bloomfield Hills, MI
  • NPI 1073976213
  Medicare reassignment NPD
• Linda Le Nguyen-Rhodes

  • Nurse Practitioner
  • Grand Rapids, MI
  • NPI 1043947658
  NPD

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375228800000",
    "number": "1760654602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 EAST PARIS AVE SE",
            "address_2": "SUITE 150",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-454-1256",
            "fax_number": "616-454-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 EAST PARIS AVE SE",
            "address_2": "SUITE 150",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-454-1256",
            "fax_number": "616-454-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RAPIDS PLASTIC SURGERY PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2013-07-31",
        "status": "A",
        "authorized_official_last_name": "FEWLESS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "616-454-1256",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0D11002",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "B0001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centre for Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Grand Rapids Plastic Surgery PLC (Centre for Plastic Surgery)
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• Plastic Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Plastic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.