NPIMap

Organization Active NPI

Center for Urologic Surgery LLC

  • Ambulatory Surgical Clinic/Center
  • Saint Louis, MO
National Provider Identifier
1093230450
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
289-0 Issued in MO
Legal business name
CENTER FOR UROLOGIC SURGERY LLC
Practice address
12855 N 40 Dr Ste 100
Saint Louis, MO 63141
Phone
(314) 594-8230
Fax
(314) 594-8246
NPI assigned
Aug 7, 2017
Last updated
Aug 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Authorized official

Name
Charles Bradford
Title
Managing Partner
Phone
(214) 738-0357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 289-0 MO Primary

Addresses

Primary practice location

12855 N 40 Dr Ste 100
Saint Louis, MO 63141

Mailing address

913 S Main St Unit 212
Grapevine, TX 76051-7582
Phone (817) 329-4611

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171228000966 MO Part B Supplier - Ambulatory Surgical Center 0345508131 Practice locations: Saint Louis, MO

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Center for Urologic SurgeryCCN 31C0001177
Medicare certification status
ActiveFrom the Provider of Services file

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Center for Urologic SurgeryCCN 26C0001164
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 1

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

Locations

12855 N 40 Dr
Ste 100
Saint Louis, MO 63141
Phone (314) 594-8230

913 S Main St
Unit 212
Grapevine, TX 76051
Phone (817) 329-4611

Practitioners & affiliated clinicians

Practitioners 10

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": "1502064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1093230450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 S MAIN ST UNIT 212",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760517582",
            "telephone_number": "817-329-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12855 N 40 DR STE 100",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-594-8230",
            "fax_number": "314-594-8246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR UROLOGIC SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-07",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "BRADFORD",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "214-738-0357"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "289-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.