Synergy Surgery Center of San Diego LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SYNERGY SURGERY CENTER OF SAN DIEGO LLC

Practice address

9095 Rio San Diego Dr Ste 100
San Diego, CA 92108-1680

Phone

(619) 819-4524

NPI assigned

Apr 4, 2024

Organization subpart

No

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

Authorized official

Name

Eric Boon

Title

Officer/Authorized Official

Phone

(480) 567-0269

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Ambulatory surgical center certification: CCN 55C0001169

Legal name

Synergy Surgery Center of San Diego LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Nov 25, 2024

Last certification

Nov 1, 2024

Facility address

9095 Rio San Diego Drive, Suite 100
San Diego, CA 92108

Member of 1

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

• VHS San Antonio Partners LLC

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

Locations

Practitioners 1

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

• Gavin Kolodge

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • San Diego, CA
  • NPI 1407210537
  NPD (past)

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

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1043062870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9095 RIO SAN DIEGO DR STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081680",
            "telephone_number": "619-819-4524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9095 RIO SAN DIEGO DR STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081680",
            "telephone_number": "619-819-4524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY SURGERY CENTER OF SAN DIEGO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Synergy Orthopedic Specialists, Inc.
• Synergy Orthopedic Specialists, Inc.
• Synergy RX LLC
• Synergy Specialists Medical Group
• Synergy Specialists Medical Group
• Syntruvia
• Sasha Sypher
• Krystianne Nicole Sypien
• Chanraksmey Cynthia Sytha
• Nicole Syzdek

• Ambulatory Surgical Clinic/Center in San Diego, CA
• Providers in San Diego, 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 Sep 5, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.