Aesthetic Surgery Center of Winter Park, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1199 Issued in FL

Legal business name

AESTHETIC SURGERY CENTER OF WINTER PARK, LLC

Practice address

4355 Bear Gully Rd
Winter Park, FL 32792-9422

Phone

(321) 282-0561

Fax

(321) 282-0565

NPI assigned

Jun 24, 2008

Last updated

Jun 24, 2008By 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

Dr. Jeffrey M. Hartog, D.M.D., M.D.NPI 1386711166

Title

Medical Director

Phone

(321) 282-0561

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861653685. Details of each certification follow.

• CCN 10C0001702 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 10C0001702

Legal name

AESTHETIC SURGERY CENTER OF WINTER PARK

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Oct 8, 2021

Last certification

Oct 8, 2021

Facility address

4355 Bear Gully Rd
Winter Park, FL 32792

Listed as

Aesthetic Surgery Center of Winter ParkCCN 10C0001465

Locations

Practitioners 1

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.

• Jeffrey Michael Hartog, JEFFREY HARTOG M.D.

  • Plastic Surgery Physician
  • Winter Park, FL
  • NPI 1386711166
  Authorized official Same address or phone

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1861653685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4355 BEAR GULLY RD",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327929422",
            "telephone_number": "321-282-0561",
            "fax_number": "321-282-0565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4355 BEAR GULLY RD",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327929422",
            "telephone_number": "321-282-0561",
            "fax_number": "321-282-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETIC SURGERY CENTER OF WINTER PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "HARTOG",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "321-282-0561",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D., M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adventist Health System/Sunbelt, Inc (AdventHealth Total Health Management Ecare)
• Adventist Health System/Sunbelt, Inc. (AdventHealth Centra Care -KIds Winter Park)
• Adventist Health System/Sunbelt, Inc. (AdventHealth Centra Care - Lee Road)
• Adventist Health Systems/Sunbelt, Inc. (AdventHealth Centra Care - Winter Park)
• Aesthetic Osteopathic Group
• Affirming Counseling and Consulting LLC
• Affirming Counseling and Consulting, LLC
• Affluent Learning Center PLLC
• Afm Healthcare
• Agape Medical Transporation LLC

• Ambulatory Surgical Clinic/Center in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.