Advanced Surgical Group, Inc.
Organization Active NPI Ambulatory Surgical Clinic/Center · Rocklin, CA
NPI 1073908604 · NPPES record last updated Sep 14, 2022
Key facts
- NPI
- 1073908604
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- ADVANCED SURGICAL GROUP, INC.
- Practice address
- 2160 Sunset Blvd
Suite 502
Rocklin, CA 95765-4790 - Phone
- (916) 258-7250
- Fax
- (916) 787-5401
- NPI assigned
- Mar 31, 2015
- Organization subpart
- No
Authorized official
- Name
- Kayvan D Haddadan, MD
- Title
- President & Chariman
- Phone
- (415) 786-6192
Practitioners 4
-
Maria Yuri Christner, CRNA
-
Lori A Hanegan, CRNA
-
Regina Jowza, CRNA
-
Kayvan D Haddadan, M.D.
Medicare Care Compare: Ambulatory surgical center
- Listed as
- Advanced Surgical Group Inc
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2065683 | Advanced Surgical Group | Certificate of waiver | Sep 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171113000493 | CA | Part B Supplier - Ambulatory Surgical Center | 9931465762 |
Receives reassigned benefits from 3 practitioners Practice locations: Rocklin, CA |
National Provider Directory
Locations
2160 Sunset Blvd
Ste 502
Rocklin, CA 95765
Phone (916) 727-6636
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Yes |
Addresses
Primary practice location
2160 Sunset Blvd
Suite 502
Rocklin, CA 95765-4790
Mailing address
2160 Sunset Blvd Ste 502
Rocklin, CA 95765-4790
Phone (916) 258-7250
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All providers in Rocklin, CA · Ambulatory Surgical Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.