Specialty ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

3406ASC-8 Issued in NV

Legal business name

SPECIALTY ASC LLC

Practice address

9499 W Charleston Blvd Ste 250
Las Vegas, NV 89117-7148

Phone

(702) 933-3600

Fax

(702) 933-3601

NPI assigned

Sep 4, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Michelle Bennion

Title

Administrator

Phone

(702) 933-3600

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Surgical Arts Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Specialty ASC LLC

  • Ambulatory Surgical Clinic/Center
  • Las Vegas, NV
  • NPI 1083669196

  9537372099

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Specialty ASC LLC

  • Ambulatory Surgical Clinic/Center
  • Las Vegas, NV
  • NPI 1083669196

  O20100930083198

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael John McKenna, M.D.

  • Interventional Pain Medicine Physician
  • Las Vegas, NV
  • NPI 1093736571
  NPD (past)
• Brian Juel Parker, MD

  • Plastic Surgery Physician
  • Las Vegas, NV
  • NPI 1952493223
  NPD (past)

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

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318204800000",
    "number": "1003064890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9499 W CHARLESTON BLVD STE 250",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891177148",
            "telephone_number": "702-933-3600",
            "fax_number": "702-933-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9499 W CHARLESTON BLVD STE 250",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891177148",
            "telephone_number": "702-933-3600",
            "fax_number": "702-933-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-04",
        "last_updated": "2011-10-10",
        "status": "A",
        "authorized_official_last_name": "BENNION",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-933-3600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NV",
            "license": "3406ASC-8",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DMERC",
            "identifier": "29C0001049",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4602060",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgical Arts Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialized Care Services LLC
• Specialty ASC LLC
• Specialty Hospice Care LLC
• Specialty Surgery Center of Pecos, LLC
• Specialty Surgicare of Las Vegas, LP
• Eugene Lewis Speck, M.D. PH. D.

• Ambulatory Surgical Clinic/Center in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Ambulatory Surgical Clinic/Center in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.