NPIMap

Organization Active NPI

Advanced Ambulatory Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Evansville, IN
National Provider Identifier
1033426580
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
1055762A Issued in IN
Legal business name
ADVANCED AMBULATORY SURGERY CENTER, LLC
Practice address
1101 Professional Blvd Ste 104
Evansville, IN 47714-8018
Phone
(812) 758-4071
Fax
(812) 205-2654
NPI assigned
Sep 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Authorized official

Name
Carrie Straw
Title
Billing
Phone
(812) 758-4034

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 1055762A IN Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1101 Professional Blvd Ste 104
Evansville, IN 47714-8018

Mailing address

1101 Professional Blvd
Suite 104
Evansville, IN 47714-8016
Phone (812) 758-4071

Other identifiers 3

IdentifierTypeStateIssuer
201070290AMedicaidIN
7100212490MedicaidKY
300113301MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120111000950 IN Part B Supplier - Ambulatory Surgical Center 6608043864 Practice locations: Evansville, IN

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Advanced Ambulatory Surgery Center LLCCCN 15C0001175
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2022497Advanced Ambulatory Surgery Center1101 Professional Blvd Suite 104, Evansville, IN 47714Certificate of waiverApr 4, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1283558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752019200000",
    "number": "1033426580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 PROFESSIONAL BLVD",
            "address_2": "SUITE 104",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477148016",
            "telephone_number": "812-758-4071",
            "fax_number": "812-205-2654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 PROFESSIONAL BLVD STE 104",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477148018",
            "telephone_number": "812-758-4071",
            "fax_number": "812-205-2654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-04",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A",
        "authorized_official_last_name": "STRAW",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "812-758-4034"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "1055762A",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201070290A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100212490",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300113301",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.