FORM MD PLASTIC SURGERY
NPI 1164053104
Otolaryngology - Otolaryngology/Facial Plastic Surgery in Mission Viejo, CA
About Form Md Plastic Surgery NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FORM MD PLASTIC SURGERY (NPI 1164053104) is a healthcare organization registered as an otolaryngology/facial plastic surgery in Mission Viejo, California and active in the NPI registry since January 2020. The organization lists Taylor R Pollei, Ceo/provider, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Form Md Plastic Surgery is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Form MD Plastic Surgery, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Form MD Plastic Surgery's NPI number?
The NPI number for Form MD Plastic Surgery is 1164053104. It was assigned to this organization in the NPPES registry on January 29, 2020.
Where is Form MD Plastic Surgery located?
Form MD Plastic Surgery is located at 26691 Plaza Ste 200, Mission Viejo, CA 92691. The listed phone number is (949) 998-2020.
What is Form MD Plastic Surgery's specialty?
The primary specialty registered for this NPI is Otolaryngology, specializing in Otolaryngology/Facial Plastic Surgery, with taxonomy code 207YX0905X.
Is Form MD Plastic Surgery enrolled in Medicare?
Yes. Form MD Plastic Surgery is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Form MD Plastic Surgery?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Otolaryngology) reassigns their Medicare billing to Form MD Plastic Surgery. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Form MD Plastic Surgery was last updated on April 26, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Form Md Plastic Surgery · NPI 1164053104
Otolaryngology/Facial Plastic Surgery organization in Mission Viejo, California. Organization record, active in the CMS NPPES registry since January 29, 2020.
## Identity
- **NPI:** 1164053104 (Entity type: Organization)
- **Enumerated:** January 29, 2020
- **Primary specialty:** Otolaryngology - Otolaryngology/Facial Plastic Surgery · taxonomy 207YX0905X
- **Organization subpart:** No
- **Authorized official:** Taylor Pollei, CEO/PROVIDER
## Practice location
- **Address:** 26691 PLAZA STE 200, Mission Viejo, CA 92691-8582
- **Phone:** (949) 998-2020
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Otolaryngology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 26, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1164053104) · Data from the CMS NPPES public registry.