Southeastern Plastic Surgery, P.a.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

SOUTHEASTERN PLASTIC SURGERY, P.A.

Practice address

2030 Fleischmann Rd
Tallahassee, FL 32308

Phone

(850) 219-2000

Fax

(850) 877-2138

NPI assigned

Oct 2, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ben J Kirbo, M.D.NPI 1720096761

Title

Surgeon/Owner

Phone

(850) 219-2000

Specialties & licenses 1

Addresses

Other names 1

• Southeastern Plastic Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 6

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

• Ben J Kirbo, MD

  • Plastic Surgery Physician
  • Tallahassee, FL
  • NPI 1720096761
  Medicare reassignment Care Compare group NPD Authorized official
• Brittany Berta, ARNP

  • Family Nurse Practitioner
  • Tallahassee, FL
  • NPI 1942792635
  Medicare reassignment Care Compare group NPD
• Leo Christopher Derosier, MD

  • Surgery Physician
  • Tallahassee, FL
  • NPI 1043425309
  Medicare reassignment Care Compare group NPD
• Laurence Zalmon Rosenberg, M.D.

  • Plastic Surgery Physician
  • Tallahassee, FL
  • NPI 1467494526
  Medicare reassignment Care Compare group NPD
• Kristen Snyder Costa, PA-C

  • Physician Assistant
  • Tallahassee, FL
  • NPI 1811102494
  Medicare reassignment Care Compare group
• Jordan Waldorff Hill, PA-C

  • Physician Assistant
  • Panama City, FL
  • NPI 1255688313
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478736000000",
    "number": "1801989884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 FLEISCHMANN RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-219-2000",
            "fax_number": "850-877-2138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 FLEISCHMANN RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-219-2000",
            "fax_number": "850-877-2138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN PLASTIC SURGERY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2016-11-10",
        "status": "A",
        "authorized_official_last_name": "KIRBO",
        "authorized_official_first_name": "BEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SURGEON/OWNER",
        "authorized_official_telephone_number": "850-219-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southeast Radiology Partners LTD
• Southeastern Behavioral Health, LLC
• Southeastern Center for Infectious Diseases PA
• Southeastern Dermatology, PA
• Southeastern Outpatient Surgery Center LLC
• Southeastern Podiatry Clinic PA
• Southeastern Surgical Group PA
• Southeastern Therapy Services, LLC
• Southeastern Urological Center PA
• Southeastern Urological Partners LLC

• Plastic and Reconstructive Surgery Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Plastic and Reconstructive Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; 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.