Prescott Outpatient Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

OSC0035 Issued in AZ

Legal business name

PRESCOTT OUTPATIENT SURGICAL CENTER LLC

Practice address

815 Ainsworth Dr
Prescott, AZ 86301-1631

Phone

(928) 778-9770

Fax

(928) 778-9028

NPI assigned

Aug 8, 2006

Last updated

Sep 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Eric Boon

Title

Officer/Authorized Official

Phone

(480) 567-0269

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Listed as

Prescott Outpatient Surgical CenterCCN 03C0001043

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Baylor University Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Dallas, TX
  • NPI 1518967231

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  dba Baptist Health System

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1083624670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 AINSWORTH DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011631",
            "telephone_number": "928-778-9770",
            "fax_number": "928-778-9028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 AINSWORTH DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011631",
            "telephone_number": "928-778-9770",
            "fax_number": "928-778-9028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT OUTPATIENT SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "480-567-0269",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AZ",
            "license": "OSC0035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "061482",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Prescott Medical Imaging, LLC
• Prescott Medical Investment LLC (Total Point Prescott Medical)
• Prescott Mobililty Store Inc
• Prescott Nursing and Rehabilitation Center LLC
• Prescott Osteoporosis Testing Center
• Prescott Periodontics & Implant Dentistry, PLLC
• Prescott Pulmonary and Sleep Specialists, PLLC (Medical provider)
• Prescott Radiation Oncology Specialists LLC (Prescott Cancer Specialists)
• Prescott Radiologists LLP (Prescott Imaging Center)
• Prescott Recovery Services LLC

• Ambulatory Surgical Clinic/Center in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.