Active NPI
Desoto Eye Surgery Center LLC
- Ambulatory Surgical Clinic/Center
- Southaven, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- Legal business name
- DESOTO EYE SURGERY CENTER LLC
- Practice address
- 726 Goodman Rd E
Suite B
Southaven, MS 38671-9530 - Phone
- (662) 349-1959
- Fax
- (662) 349-0424
- NPI assigned
- Mar 11, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Alan R. Schaeffer, M.D.
- Title
- Managing Member
- Phone
- (662) 349-1959
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Primary |
Addresses
Primary practice location
726 Goodman Rd E
Suite B
Southaven, MS 38671-9530
Mailing address
726 Goodman Rd E
Suite B
Southaven, MS 38671-9530
Phone (662) 349-1959
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00959926 | Other | MS | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110125000282 | MS | Part B Supplier - Ambulatory Surgical Center | 3274712179 | Practice locations: Southaven, MS |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D1098836 | Desoto Eye Surgery Center LLC | Certificate of waiver | Apr 28, 2027 |
National Provider Directory
National Provider DirectoryLocations
726 Goodman Rd E
Southaven, MS 38671
Phone (662) 349-1959
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Ophthalmology Physician
- Southaven, MS
- NPI 1912937574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236729600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1333584000000",
"number": "1073754602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "726 GOODMAN RD E",
"address_2": "SUITE B",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386719530",
"telephone_number": "662-349-1959",
"fax_number": "662-349-0424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "726 GOODMAN RD E",
"address_2": "SUITE B",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386719530",
"telephone_number": "662-349-1959",
"fax_number": "662-349-0424"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DESOTO EYE SURGERY CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-03-11",
"last_updated": "2012-04-05",
"status": "A",
"authorized_official_last_name": "SCHAEFFER",
"authorized_official_first_name": "ALAN",
"authorized_official_middle_name": "R.",
"authorized_official_title_or_position": "MANAGING MEMBER",
"authorized_official_telephone_number": "662-349-1959",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00959926",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; 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.