Southfield Endoscopy ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

636911 Issued in MI

Legal business name

SOUTHFIELD ENDOSCOPY ASC LLC

Doing business as

Gastrointestinal Endoscopy Center

Practice address

264 W Maple Rd
Suite 100
Troy, MI 48084-5435

Phone

(248) 269-5594

Fax

(248) 269-6546

NPI assigned

Feb 10, 2006

Last updated

Sep 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Snodgrass

Title

President

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gastrointestinal Endoscopy Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Southfield Endoscopy ASC LLCCCN 23C0001046

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

Locations

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1104899855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 W MAPLE RD",
            "address_2": "SUITE 100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480845435",
            "telephone_number": "248-269-5594",
            "fax_number": "248-269-6546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 W MAPLE RD",
            "address_2": "SUITE 100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480845435",
            "telephone_number": "248-269-5594",
            "fax_number": "248-269-6546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFIELD ENDOSCOPY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-10",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "SNODGRASS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": "636911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "94321929",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gastrointestinal Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gastrointestinal Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rachel L. Soriano, NP
• Olivia Kathleen Soter
• Source One Medical Inc
• Rhonda Struble Sousley, PHD, MSOM
• Southeastern Michigan Cardiovascular Surgeons PLLC
• Lisa Denise Sowels, PA-C
• Richard K Sowerby, D.C.
• Michael Scott Sowles
• Ronald Spalter, OD
• Kimberly Ann Spampinato, MA, LPC

• Ambulatory Surgical Clinic/Center in Troy, MI
• Providers in Troy, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.