NPIMap

Organization Active NPI

Sutter Bay Medical Foundation

Doing business as Sutter Samaritan Surgery Center

  • Ambulatory Surgical Clinic/Center
  • San Jose, CA
National Provider Identifier
1033817168
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SUTTER BAY MEDICAL FOUNDATION
Doing business as
Sutter Samaritan Surgery Center
Practice address
2506 Samaritan CT
San Jose, CA 95124-4001
Phone
(408) 203-3941
NPI assigned
Feb 17, 2023
Last updated
Feb 17, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SUTTER BAY MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

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

Authorized official

Name
Melody States, RN
Title
Executive Director
Phone
(916) 566-4771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

2506 Samaritan CT
San Jose, CA 95124-4001

Mailing address

2506 Samaritan CT
San Jose, CA 95124-4001
Phone (408) 203-3941

Other names 1

  • Sutter Samaritan Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230407001373 CA Part B Supplier - Ambulatory Surgical Center 4284538778 Receives reassigned benefits from 232 practitioners
Practice locations: San Jose, CA

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Sutter Bay Medical Foundation Dba Sutter Samaritan Surgery CenterCCN 55C0001157
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
05D2287079Sutter Samaritan Surgery Center2506 Samaritan Court, San Jose, CA 95124Certificate of waiverAug 7, 2027

National Provider Directory

National Provider Directory
Part of
Palo Alto Med FDN HLTH

Locations

2506 Samaritan Ct
Fl 1
San Jose, CA 95124

Practitioners & affiliated clinicians

Practitioners 233

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 233

NPI Registry JSON

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

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1033817168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 SAMARITAN CT",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951244001",
            "telephone_number": "408-203-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2506 SAMARITAN CT",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951244001",
            "telephone_number": "408-203-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER BAY MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUTTER BAY MEDICAL FOUNDATION",
        "enumeration_date": "2023-02-17",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "STATES",
        "authorized_official_first_name": "MELODY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "916-566-4771",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sutter Samaritan Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; 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.