Southern Indiana Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

06-006102-1 Issued in IN

Legal business name

SOUTHERN INDIANA SURGERY CENTER, LLC

Doing business as

Southern Indiana Surgery Center

Practice address

2800 Rex Grossman Blvd
Bloomington, IN 47403-5145

Phone

(812) 333-8969

Fax

(812) 335-2309

NPI assigned

Oct 19, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Misty Scales

Title

Business Office Manager

Phone

(812) 333-8969

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southern Indiana Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

Southern Indiana Surgery CenterCCN 15C0001037

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 1

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

• Indiana University Health Bloomington Inc

  • General Acute Care Hospital
  • Bloomington, IN
  • NPI 1205860335

  Member Of

  NPD member

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Edward Johnson, M.D.

  • Otolaryngology Physician
  • Bloomington, IN
  • NPI 1831171305
  NPD
• Matthew A Parmenter, DPM

  • Podiatrist
  • Linton, IN
  • NPI 1013902089
  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268611200000",
    "number": "1083796221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 REX GROSSMAN BLVD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035145",
            "telephone_number": "812-333-8969",
            "fax_number": "812-335-2309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 REX GROSSMAN BLVD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035145",
            "telephone_number": "812-333-8969",
            "fax_number": "812-335-2309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INDIANA SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2010-03-15",
        "status": "A",
        "authorized_official_last_name": "SCALES",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "812-333-8969",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "06-006102-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100274500A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Indiana Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southern Indiana Pediatric Dentistry, LLC
• Southern Indiana Pediatrics, LLC
• Southern Indiana Physicians for Women
• Southern Indiana Radiological Associates Inc
• Southern Indiana Senior Care, Inc
• Melanie Southern
• Southerncare, Inc.
• Southerncare, Inc.
• Sofia Margarita Souto, M.A., CCC-SLP
• Nathan Sparks, RBT

• Ambulatory Surgical Clinic/Center in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; 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.