Form MD Plastic Surgery
NPI 1164053104 · Otolaryngology/Facial Plastic Surgery Physician · Mission Viejo, CA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Form MD Plastic Surgery is a Otolaryngology/Facial Plastic Surgery Physician organization in Mission Viejo, CA (NPI 1164053104).
Provider details
- NPI number
- 1164053104
- Entity type
- Organization
- Primary specialty
- Otolaryngology/Facial Plastic Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Taylor Pollei, Ceo/Provider(949) 998-2020
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Surgery Physician208600000X
Allopathic & Osteopathic Physicians
- Medical Specialty Clinic/Center261QM2500X
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2020-01-29
- Last updated
- 2023-04-26
- Certified
- 2023-04-26
Frequently asked questions
- What is Form MD Plastic Surgery's NPI number?
- Form MD Plastic Surgery's National Provider Identifier (NPI) is 1164053104, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Form MD Plastic Surgery?
- Form MD Plastic Surgery is classified in the NPPES registry as Otolaryngology/Facial Plastic Surgery Physician (Allopathic & Osteopathic Physicians).
- Where is Form MD Plastic Surgery located?
- Form MD Plastic Surgery's practice location on file with NPPES is 26691 Plaza Ste 200, Mission Viejo, CA 92691-8582.
- What is Form MD Plastic Surgery's phone number?
- The practice phone number listed in the NPPES registry for Form MD Plastic Surgery is (949) 998-2020.
- Does Form MD Plastic Surgery accept Medicare?
- Form MD Plastic Surgery is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Form MD Plastic Surgery?
- The authorized official listed on Form MD Plastic Surgery's NPPES record is Taylor Pollei, Ceo/Provider. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Form MD Plastic Surgery's NPI active?
- Yes — Form MD Plastic Surgery's NPI (1164053104) is active in the NPPES registry as of the last update on 2023-04-26.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.