Pcasc, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PCASC, LLC

Doing business as

Surgery Center of the Northland

Practice address

1101 Kentucky Avenue
Platte City, MO 64079

Phone

(816) 232-1049

NPI assigned

Jul 29, 2025

Organization subpart

No

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

Authorized official

Name

Blake Peterson, MD

Title

Member

Phone

(816) 232-1049

Specialties & licenses 1

Addresses

Other names 1

• Surgery Center of the Northland Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Ambulatory surgical center certification: CCN 26C0001186

Legal name

Surgery Center of the Northland

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

May 21, 2026

Last certification

May 21, 2026

Facility address

1101 Kentucky Avenue
Platte City, MO 64079

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755648000000",
    "number": "1013890813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 KENTUCKY AVENUE",
            "city": "PLATTE CITY",
            "state": "MO",
            "postal_code": "64079",
            "telephone_number": "816-232-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 KENTUCKY AVENUE",
            "city": "PLATTE CITY",
            "state": "MO",
            "postal_code": "64079",
            "telephone_number": "816-232-1049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-29",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "816-232-1049",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgery Center of the Northland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Surgery Center of the Northland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Platte City, MO
• Providers in Platte City, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.