Great Lakes Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GREAT LAKES SURGERY CENTER LLC

Practice address

2848 Niles Rd
Suite B
Saint Joseph, MI 49085-3352

Phone

(269) 428-3304

NPI assigned

Jan 20, 2016

Organization subpart

No

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

Authorized official

Name

Dr. David N. Brown, M.D.

Title

Manager Member

Phone

(269) 428-3300

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Great Lakes Surgery Ctr LLCCCN 23C0001131

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Great Lakes Eye Care, P.C.

  • Durable Medical Equipment & Medical Supplies
  • South Haven, MI
  • NPI 1114058369

  Member Of

  NPD member

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

{
    "created_epoch": "1453248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636675200000",
    "number": "1003273129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2848 NILES RD",
            "address_2": "SUITE B",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853352",
            "telephone_number": "269-428-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2848 NILES RD",
            "address_2": "SUITE B",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853352",
            "telephone_number": "269-428-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-20",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "MANAGER MEMBER",
        "authorized_official_telephone_number": "269-428-3300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Eye Care PC
• Great Lakes Family Dental Group-St. Joseph
• Great Lakes Gastroenterology PLLC
• Great Lakes Heart & Vascular Institute, P.C.
• Great Lakes Sports Medicine and Concussion Clinic
• Mark H Greenberg, MD
• Adrienne Greene, DPT
• Edward Glendon Greene, MPH, PT
• Samuel Z Gregor, CRNA
• Gregory E. Bauman, DDS, PLC

• Ambulatory Surgical Clinic/Center in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.