Bayhealth Berkeley Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BAYHEALTH BERKELEY SURGERY CENTER, LLC

Doing business as

Berkeley Surgery Center

Practice address

3100 San Pablo Ave Ste 180B
Berkeley, CA 94702-2498

Phone

(530) 848-3566

NPI assigned

Mar 26, 2024

Last updated

Jun 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kelly Mather

Title

Chief Executive Officer

Phone

(707) 349-4012

Specialties & licenses 1

Addresses

Other names 1

• Berkeley Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043060403. Details of each certification follow.

• CCN 55C0001213 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 55C0001213

Legal name

Berkeley Surgery Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Nov 13, 2025

Last certification

Nov 14, 2025

Facility address

3100 San Pablo Avenue
Berkeley, CA 94702

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.

• Bayhealth Medical Center, Inc.

  dba Bayhealth Medical Oncology, Sussex Campus

  • Medical Oncology Physician
  • Milford, DE
  • NPI 1104383041

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1043060403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SAN PABLO AVE STE 180B",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022498",
            "telephone_number": "707-349-4012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SAN PABLO AVE STE 180B",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022498",
            "telephone_number": "530-848-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYHEALTH BERKELEY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "MATHER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-349-4012",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berkeley Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Berkeley Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angela Fereshteh Bayat, DDS
• Baychildren's Physicians
• Baychildren's Physicians
• Baychildren's Physicians
• Bayer Reference Testing Laboratory
• Micheline Beam, PHD
• Dianna Beamon
• Laroy Beamon
• Jasper Bear, INTERN
• Jasmine Nicole Beard

• Ambulatory Surgical Clinic/Center in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.