NPIMap

Organization Active NPI

Spring Park Surgery Center L L C

  • Ambulatory Surgical Clinic/Center
  • Davenport, IA
National Provider Identifier
1073516795
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SPRING PARK SURGERY CENTER L L C
Practice address
3319 Spring St
Ste 202a
Davenport, IA 52807-2125
Phone
(563) 355-6236
Fax
(563) 359-4634
NPI assigned
May 27, 2005
Last updated
Nov 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

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

Authorized official

Name
Katrina Mae Masakowski
Title
Business Office Manager
Phone
(563) 359-1716

Specialties & licenses 1

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

Addresses

Primary practice location

3319 Spring St
Ste 202a
Davenport, IA 52807-2125

Mailing address

3319 Spring St
Ste 202a
Davenport, IA 52807-2125
Phone (563) 355-6236

Other identifiers 3

IdentifierTypeStateIssuer
0610154MedicaidIA
61015OtherIAWELLMARK BCBS
490004256OtherIAMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050610000553 IA Part B Supplier - Ambulatory Surgical Center 6901840933 Practice locations: Davenport, IA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Spring Park Surgery Center LLCCCN 16C0001001
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
16D1097399Spring Park Surgery Center, LLC3319 Spring Street, Suite 202a, Davenport, IA 52807Certificate of waiverMar 24, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to 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": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1073516795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3319 SPRING ST",
            "address_2": "STE 202A",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072125",
            "telephone_number": "563-355-6236",
            "fax_number": "563-359-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3319 SPRING ST",
            "address_2": "STE 202A",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072125",
            "telephone_number": "563-355-6236",
            "fax_number": "563-359-4634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING PARK SURGERY CENTER L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "MASAKOWSKI",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "563-359-1716"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0610154",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "61015",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "490004256",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; 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.