Sagamore Surgical Services, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

05-006126-1 Issued in IN

Legal business name

SAGAMORE SURGICAL SERVICES, INC.

Practice address

2320 Concord Rd
Ste B
Lafayette, IN 47909-2708

Phone

(765) 474-7854

NPI assigned

Jul 28, 2005

Organization subpart

No

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

Authorized official

Name

Shelby Atkinson Brouillette, RN

Title

Administrator Don

Phone

(765) 474-7838

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

Sagamore Surgical Services IncCCN 15C0001041

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.

• Franciscan Health Lafayette

  • Home Infusion Therapy Pharmacy
  • Lafayette, IN
  • NPI 1275616351

  Member Of

  NPD member

Practitioners 1

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

• Peter J Hillsamer, M.D.

  • Otolaryngology Physician
  • Lafayette, IN
  • NPI 1316026545
  NPD (past)

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1003816307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 112",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473080112",
            "telephone_number": "765-284-0493",
            "fax_number": "765-284-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 CONCORD RD",
            "address_2": "STE B",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479092708",
            "telephone_number": "765-474-7854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGAMORE SURGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-28",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "BROUILLETTE",
        "authorized_official_first_name": "SHELBY",
        "authorized_official_middle_name": "ATKINSON",
        "authorized_official_title_or_position": "ADMINISTRATOR DON",
        "authorized_official_telephone_number": "765-474-7838",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "05-006126-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100274550A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nevaeh Jordan Rush
• Angela Elaine Rusk, PT
• Gail L. Rutan, NP
• Joseph Clayton Rutledge, MD
• Ivy Rynearson, CNS
• Daniel Edward Sakel, DDS
• Irfan T Salam, PHARMD
• Gabriel Salamie, MD
• Carlos Salazar Carcamo, M.D.
• Erin Salazar, RD, LD

• Ambulatory Surgical Clinic/Center in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; 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.