Surgicare Center of Idaho, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGICARE CENTER OF IDAHO, LLC

Practice address

360 E Mallard Dr
Ste 125
Boise, ID 83706-3941

Phone

(208) 336-8700

Fax

(208) 426-0902

NPI assigned

Jun 22, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Louis Pennow, MBA

Title

Director

Phone

(208) 336-8700

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Ambulatory surgical center certification: CCN 13C0001014

Legal name

SURGICARE CENTER OF IDAHO

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Apr 1, 1994

Last certification

Oct 18, 2019

Ownership / control type

Proprietary

Facility address

360 East Mallard Drive, Suite 125
Boise, ID 83706

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

Practitioners 1

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

• Scott Woolf, M.D.

  • Glaucoma Specialist (Ophthalmology) Physician
  • Boise, ID
  • NPI 1629509682
  NPD

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1114923471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E MALLARD DR",
            "address_2": "STE 125",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066644",
            "telephone_number": "208-336-8700",
            "fax_number": "208-426-0902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E MALLARD DR",
            "address_2": "STE 125",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063941",
            "telephone_number": "208-336-8700",
            "fax_number": "208-426-0902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICARE CENTER OF IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "PENNOW",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "208-336-8700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273390",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryan I Sundy, PT
• Sunflower Speech Services, LLC
• Sunhealth Behavioral Systems for Boise
• Mousoomi M. Sur, MD
• Alicia Paige Surber
• Susan J. Hegstad, M.D., PA
• Susan Martin Therapy and Wellness PLLC
• Sally Suter, FNP ND
• Kathleen R. Sutherland, MD
• Andrea Sutton

• Ambulatory Surgical Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.