West Lakes Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

NA

Legal business name

WEST LAKES SURGERY CENTER LLC

Practice address

12499 University Ave
Suite 100
Clive, IA 50325-8281

Phone

(515) 974-5050

NPI assigned

Aug 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Teri S Formanek, M.D.

Title

President

Phone

(515) 327-1555

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Listed as

West Lakes Surgery Center LLCCCN 16C0001026

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

Member of 1

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

• Urology Center of Iowa PLLC

  • Urology Physician
  • Clive, IA
  • NPI 1689210155

  Member Of

  NPD member

Locations

Practitioners 1

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

• Dennis Paul Dornbier, D.O.

  • Obstetrics & Gynecology Physician
  • Des Moines, IA
  • NPI 1306944525
  NPD (past)

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591228800000",
    "number": "1104933696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 S INGRAM MILL RD",
            "address_2": "BUILDING B",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044042",
            "telephone_number": "417-889-2040",
            "fax_number": "417-889-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12499 UNIVERSITY AVE",
            "address_2": "SUITE 100",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258281",
            "telephone_number": "515-974-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST LAKES SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "FORMANEK",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "515-327-1555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0610352",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL EMPLOYEES HEALTH",
            "identifier": "61026",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARPENTERS DISTRICT COUN",
            "identifier": "F252394",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "F252394",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "61026",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS AETNA",
            "identifier": "F252394",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK HEALTH PLANS IA",
            "identifier": "61026",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooklynn Marie Way, TLMHC
• Corey R Weaver, ARNP
• Lydia Jane Krzyzak Weir
• Michelle Lynn Welsh, R.PH.
• West End Chiropractic LLC
• Jill Suzanne Westercamp, M.D.
• Westown Parkway Dental Affiliates, PC
• Robin Westrum, ARNP
• Lindsey White-Rethwisch, DC
• Sarah White, MS CADC LMHC

• All providers in Clive, IA
• Ambulatory Surgical Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.