NPIMap

Organization Active NPI

Summit Cosmetic Surgery Center,PA

  • Surgery Physician
  • Wilmington, NC
National Provider Identifier
1922061092
Registry record updated Jan 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SUMMIT COSMETIC SURGERY CENTER,PA
Practice address
1717 Shipyard Blvd
Suite 100
Wilmington, NC 28403-8019
Phone
(910) 794-5355
Fax
(910) 794-5358
NPI assigned
Apr 10, 2006
Last updated
Jan 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2011

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

Authorized official

Name
Dr. Edward J Ricciardelli, MDNPI 1073518064
Title
Owner
Phone
(910) 794-5355

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
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1717 Shipyard Blvd
Suite 100
Wilmington, NC 28403-8019

Mailing address

1717 Shipyard Blvd
Suite 100
Wilmington, NC 28403-8019
Phone (910) 794-5355

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040909001391 NC Part B Supplier - Clinic/Group Practice 7911973987 Receives reassigned benefits from 13 practitioners
Practice locations: Supply, NC; Wilmington, NC; Hampstead, NC

National Provider Directory

National Provider Directory

Locations

14507 US Hwy 17 Ste 130
Hampstead, NC 28443

206 N Dyson St
Holly Ridge, NC 28445
Phone (910) 329-7591

58 Physicians Dr NW
Supply, NC 28462
Phone (910) 755-5437

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294099200000",
    "number": "1922061092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 SHIPYARD BLVD",
            "address_2": "SUITE 100",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284038019",
            "telephone_number": "910-794-5355",
            "fax_number": "910-794-5358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 SHIPYARD BLVD",
            "address_2": "SUITE 100",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284038019",
            "telephone_number": "910-794-5355",
            "fax_number": "910-794-5358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT COSMETIC SURGERY CENTER,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2011-01-04",
        "status": "A",
        "authorized_official_last_name": "RICCIARDELLI",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-794-5355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; 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.