Pacific Endoscopy and Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PACIFIC ENDOSCOPY AND SURGERY CENTER, LLC

Practice address

17815 Newhope St
Suite R
Fountain Valley, CA 92708-5426

Phone

(714) 432-8881

NPI assigned

Nov 7, 2007

Organization subpart

No

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

Authorized official

Name

Eric Boon

Title

Authorized Official

Phone

(480) 567-0269

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Pacific Endoscopy and Surgery Center LLCCCN 05C0001803

Medicare certification status

ActiveFrom the Provider of Services file

Member of 3

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

• UC Irvine Health Cancer Center, Newport Pacific Medical Center

  • Infusion Therapy Clinic/Center
  • Costa Mesa, CA
  • NPI 1558783696

  Member Of

  NPD member
• Baylor University Medical Center

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1447250253

  Member Of

  NPD member
• VHS San Antonio Partners LLC

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

  Member Of

  NPD member

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1104006006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17815 NEWHOPE ST",
            "address_2": "SUITE R",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927085426",
            "telephone_number": "714-432-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17815 NEWHOPE ST",
            "address_2": "SUITE R",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927085426",
            "telephone_number": "714-432-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC ENDOSCOPY AND SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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": []
}

• Pacific City Recovery
• Pacific Coast Hematology Oncology Medical Group Inc
• Pacific Coast Institute Rehab and Physical Therapy Inc.
• Pacific Coast Multi Specialty Surgery, LLC
• Pacific Coast Speech Therapy, Inc
• Pacific Endoscopy Center, LLC
• Pacific Pain Managment
• Pacific Renal Care Medical Corp
• Pacific Sleep Medicine Services Inc
• Susana Maria Paez

• Ambulatory Surgical Clinic/Center in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Ambulatory Surgical Clinic/Center in California

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