NPIMap

Organization Active NPI

Regency Reconstruction PLLC

  • Plastic and Reconstructive Surgery Physician
  • Phoenix, AZ
National Provider Identifier
1972086924
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
REGENCY RECONSTRUCTION PLLC
Practice address
10240 W Indian School Rd Ste 115
Phoenix, AZ 85037-5905
Phone
(623) 251-6431
NPI assigned
Sep 14, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Jason Mussman, MDNPI 1144430182
Title
Owner
Phone
(989) 255-4794

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
Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0122X Primary

Addresses

Primary practice location

10240 W Indian School Rd Ste 115
Phoenix, AZ 85037-5905

Mailing address

10240 W Indian School Rd Ste 115
Phoenix, AZ 85037-5905
Phone (623) 251-6431

Other identifiers 1

IdentifierTypeStateIssuer
961095MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181113000903 AZ Part B Supplier - Clinic/Group Practice 4082968995 Receives reassigned benefits from 13 practitioners
Practice locations: Phoenix, AZ; Surprise, AZ

National Provider Directory

National Provider Directory

Locations

10240 W Indian School Rd
Ste 100
Phoenix, AZ 85037
Phone (623) 907-2377

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1972086924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10240 W INDIAN SCHOOL RD STE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375905",
            "telephone_number": "623-251-6431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10240 W INDIAN SCHOOL RD STE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375905",
            "telephone_number": "623-251-6431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENCY RECONSTRUCTION PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-14",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "MUSSMAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-255-4794",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "961095",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.