Active NPI
The Surgery Center at Jensen Beach, LLC
- Ambulatory Surgical Clinic/Center
- Jensen Beach, FL
National Provider Identifier
1093772840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- License
- 1197
- Legal business name
- THE SURGERY CENTER AT JENSEN BEACH, LLC
- Practice address
- 3995 NW Golden Rod Road
Jensen Beach, FL 34957 - Phone
- (772) 497-0020
- Fax
- (772) 497-0021
- NPI assigned
- Apr 26, 2006
- 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
- Collin Lemaistre
- Title
- Officer/Authorized Offical
- Phone
- (214) 213-0723
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 1197 | FL | Primary |
Addresses
Primary practice location
3995 NW Golden Rod Road
Jensen Beach, FL 34957
Mailing address
3995 NW Golden Rod Road
Jensen Beach, FL 34957
Phone (772) 497-0020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 075781100 | Medicaid | FL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040428001378 | FL | Part B Supplier - Ambulatory Surgical Center | 2264429596 | Practice locations: Jensen Beach, FL |
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- The Surgery Center at Jensen Beach LLC
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryMember of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Dallas, TX
- NPI 1518967231
Member Of
-
dba Baptist Health System
- Psychiatric Hospital Unit
- San Antonio, TX
- NPI 1487633509
Member Of
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Orthopaedic Surgery Physician
- West Orange, NJ
- NPI 1376590646
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1733270400000",
"number": "1093772840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3995 NW GOLDEN ROD ROAD",
"city": "JENSEN BEACH",
"state": "FL",
"postal_code": "34957",
"telephone_number": "772-497-0020",
"fax_number": "772-497-0021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3995 NW GOLDEN ROD ROAD",
"city": "JENSEN BEACH",
"state": "FL",
"postal_code": "34957",
"telephone_number": "772-497-0020",
"fax_number": "772-497-0021"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE SURGERY CENTER AT JENSEN BEACH, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-26",
"last_updated": "2024-12-04",
"certification_date": "2024-12-04",
"status": "A",
"authorized_official_last_name": "LEMAISTRE",
"authorized_official_first_name": "COLLIN",
"authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICAL",
"authorized_official_telephone_number": "214-213-0723"
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": "FL",
"license": "1197",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "075781100",
"state": "FL"
}
],
"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": []
}
Other providers in Jensen Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.