NPIMap

Organization Active NPI

Triad Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Muskogee, OK
National Provider Identifier
1043216617
Registry record updated Jun 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
0061 Issued in OK
Legal business name
TRIAD SURGERY CENTER LLC
Practice address
3131 Military Blvd
Muskogee, OK 74401-2290
Phone
(918) 687-6600
Fax
(918) 687-6610
NPI assigned
Jun 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2019

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

Authorized official

Name
Ryan Patrick Conley
Title
Owner/Manager
Phone
(918) 687-6600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 0061 OK Primary
Ambulatory Surgical Clinic/Center 261QA1903X

Addresses

Primary practice location

3131 Military Blvd
Muskogee, OK 74401-2290

Mailing address

6140 S Memorial Dr
Tulsa, OK 74133-1933
Phone (918) 252-2020

Other identifiers 3

IdentifierTypeStateIssuer
490004258OtherOKMEDICARE ID
100738620CMedicaidOK
CO5028OtherOKRAILROAD MEDICARE

Other names 2

  • Triad Eye Institute Former legal business name
  • Triad Eye Medical Clinic And Cataract Institute PLLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190826003198 OK Part B Supplier - Ambulatory Surgical Center 3173838620 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grove, OK; Muskogee, OK; Tulsa, OK; Bartlesville, OK

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Triad Eye Institute PLLCCCN 37C0001039
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Triad Eye Institute6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 N Hickerson Dr
Cleveland, OK 74020
Phone (918) 358-1600

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561507200000",
    "number": "1043216617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 S MEMORIAL DR",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741331933",
            "telephone_number": "918-252-2020",
            "fax_number": "918-307-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 MILITARY BLVD",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744012290",
            "telephone_number": "918-687-6600",
            "fax_number": "918-687-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2019-06-26",
        "status": "A",
        "authorized_official_last_name": "CONLEY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "918-687-6600"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OK",
            "license": "0061",
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "490004258",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100738620C",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CO5028",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Triad Eye Institute",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Triad Eye Medical Clinic And Cataract Institute PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Triad Eye Medical Clinic And Cataract Institute PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Muskogee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; 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.