NPIMap

Organization Active NPI

Plastic Surgery Northwest PLLC

  • Plastic Surgery Physician
  • Spokane, WA
National Provider Identifier
1780714139
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
00027337 Issued in WA
Legal business name
PLASTIC SURGERY NORTHWEST PLLC
Practice address
530 S Cowley St
Ste 100
Spokane, WA 99202-1316
Phone
(509) 838-7028
Fax
(509) 623-2177
NPI assigned
Mar 6, 2007
Last updated
Jul 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Authorized official

Name
Mrs. Sandra Conner
Title
Revenue Cycle Manager
Phone
(509) 321-4110

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 00032173 WA
Plastic Surgery Physician 208200000X 00027337 WA Primary

Addresses

Primary practice location

530 S Cowley St
Ste 100
Spokane, WA 99202-1316

Mailing address

530 S Cowley St
Ste 100
Spokane, WA 99202-1316
Phone (509) 838-7028

Other identifiers 1

IdentifierTypeStateIssuer
7139520MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071102000548 WA Part B Supplier - Clinic/Group Practice 8022105329 Receives reassigned benefits from 11 practitioners
Practice locations: Spokane, WA

National Provider Directory

National Provider Directory

Locations

530 S Cowley St
Spokane, WA 99202
Phone (509) 838-1010

530 S Cowley St
Ste 100
Spokane, WA 99202
Phone (509) 838-7028

820 S McClellan St
Spokane, WA 99204
Phone (509) 353-3973

820 S McClellan St
Ste 300
Spokane, WA 99204
Phone (509) 464-7880

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1780714139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 S COWLEY ST",
            "address_2": "STE 100",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021316",
            "telephone_number": "509-838-7028",
            "fax_number": "509-623-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 S COWLEY ST",
            "address_2": "STE 100",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021316",
            "telephone_number": "509-838-7028",
            "fax_number": "509-623-2177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGERY NORTHWEST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "CONNER",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "509-321-4110",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "WA",
            "license": "00032173",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "WA",
            "license": "00027337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7139520",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.