NPIMap

Organization Active NPI

West Plains Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • West Plains, MO
National Provider Identifier
1073509733
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
160-0 Issued in MO
Legal business name
WEST PLAINS SURGERY CENTER LLC
Practice address
1401 Doctors Dr
West Plains, MO 65775-4754
Phone
(417) 256-1400
Fax
(417) 256-2885
NPI assigned
Sep 27, 2005
Last updated
Jul 10, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Authorized official

Name
Ms. Angela M. Worley
Title
Administrator
Phone
(417) 256-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 160-0 MO Primary

Addresses

Primary practice location

1401 Doctors Dr
West Plains, MO 65775-4754

Mailing address

1401 Doctors Dr
West Plains, MO 65775-4754
Phone (417) 256-1400

Other identifiers 3

IdentifierTypeStateIssuer
000040088OtherMOMEDICARE PTAN
160-0OtherMOSTATE LICENSE
507268902MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050923000030 MO Part B Supplier - Ambulatory Surgical Center 7315971942 Receives reassigned benefits from 7 practitioners
Practice locations: West Plains, MO

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
West Plains Ambulatory Surgery CenterCCN 26C0001100
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
26D1040263West Plains Ambulatory Surgery Center1401 Doctors Drive, West Plains, MO 65775Certificate of waiverMay 4, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436486400000",
    "number": "1073509733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 DOCTORS DR",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657754754",
            "telephone_number": "417-256-1400",
            "fax_number": "417-256-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 DOCTORS DR",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657754754",
            "telephone_number": "417-256-1400",
            "fax_number": "417-256-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST PLAINS SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2015-07-10",
        "status": "A",
        "authorized_official_last_name": "WORLEY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "417-256-1400",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "160-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "000040088",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "160-0",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507268902",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Plains, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; 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.