Surgery Center of St. Joseph, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

119-3 Issued in MO

Legal business name

SURGERY CENTER OF ST. JOSEPH, LLC

Practice address

3201 Ashland Ave
Saint Joseph, MO 64506-1504

Phone

(816) 279-0079

Fax

(816) 364-1100

NPI assigned

Jul 5, 2006

Organization subpart

No

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

Authorized official

Name

Angela J Fry

Title

Clinic Director

Phone

(816) 279-0079

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Listed as

Surgery Center of St JosephCCN 26C0001012

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Novamed Surgery Center of St Joseph LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Novamed Surgery Center of St. Joseph, LLC

  • Ambulatory Surgical Clinic/Center
  • Saint Joseph, MO
  • NPI 1992706295
  NPD tax ID

Practitioners 2

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

• Christopher J Pole, M.D.

  • Ophthalmology Physician
  • Overland Park, KS
  • NPI 1285883231

  MO

  Medicare reassignment NPD
• Scott J McKnight, MD

  • Ophthalmology Physician
  • Liberty, MO
  • NPI 1164458998
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333584000000",
    "number": "1104857523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 ASHLAND AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645061504",
            "telephone_number": "816-279-0079",
            "fax_number": "816-901-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 ASHLAND AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645061504",
            "telephone_number": "816-279-0079",
            "fax_number": "816-364-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER OF ST. JOSEPH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2012-04-05",
        "status": "A",
        "authorized_official_last_name": "FRY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "816-279-0079"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "119-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502343502",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SUPPLIER",
            "identifier": "26C0001012",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Anna Stueve, M.D.
• Avery Elizabeth Sumner
• Daniel Bruce Sunderland, PHARMD
• Evangeline Suppes
• Dorairaj Suresh, MD
• Sheila Ann Surmeier, OTR
• Susan C Charles DDS LLC
• Susan Droe Inc.
• Kaitlin Sutton, LPC
• Sweet Tooth St. Joseph

• Ambulatory Surgical Clinic/Center in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; 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.