Surgical Associates Endoscopy Clinic LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

48090 Issued in SD

Legal business name

SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC

Doing business as

Avera Endoscopy/Surgical Center

Practice address

310 S Pennsylvania St
Suite 201
Aberdeen, SD 57401-4553

Phone

(605) 229-1367

Fax

(605) 229-1002

NPI assigned

Dec 21, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Bradley W Olson

Title

General Manager

Phone

(605) 229-1367

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• AVERA ENDOSCOPY/SURGICAL CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Listed as

Surgical Associates Endoscopy Clinic LLCCCN 43C0001018

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

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

• Avera St. Luke'S

  dba Avera Medical Group Radiology Aberdeen

  • Diagnostic Radiology Physician
  • Aberdeen, SD
  • NPI 1437192721

  Member Of

  NPD member

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239667200000",
    "number": "1033195912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S PENNSYLVANIA ST",
            "address_2": "SUITE 201",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014553",
            "telephone_number": "605-229-1367",
            "fax_number": "605-229-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S PENNSYLVANIA ST",
            "address_2": "SUITE 201",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014553",
            "telephone_number": "605-229-1367",
            "fax_number": "605-229-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-21",
        "last_updated": "2009-04-14",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "605-229-1367",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "SD",
            "license": "48090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5490320",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVERA ENDOSCOPY/SURGICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leonard Suel, PT
• Sandra Summers, NP
• Nicole Sumner
• Jessica Sumption
• Melissa Dawn Sundstrom, COTA/L
• Susan W. Ramig M.D., LTD.
• Brittany Denyl Sutton, D.C.
• SV Grace LLC
• Matthew William Svensen
• Lachelle Swanson, RBT

• Ambulatory Surgical Clinic/Center in Aberdeen, SD
• Providers in Aberdeen, SD by specialty
• Ambulatory Surgical Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2009; 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.