South Kansas City Surgical Center, LC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

S046019 Issued in KS

Legal business name

SOUTH KANSAS CITY SURGICAL CENTER, LC

Doing business as

South Kansas City Surgicenter

Practice address

10730 Nall Ave
Suite 100
Overland Park, KS 66211-1206

Phone

(913) 901-9000

Fax

(913) 901-9030

NPI assigned

Jun 30, 2005

Last updated

Jul 30, 2021By 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

Mrs. Christine Blackburn, BSN, RN, CNOR

Title

Administrator

Phone

(913) 901-9000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Kansas City Surgicenter Doing business as

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Listed as

South Kansas City Surgical Center Dba South Kansas City SurgicenterCCN 17C0001056

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.

• Prime Healthcare Services - Kansas City, LLC

  dba St. Joseph Medical Center

  • General Acute Care Hospital
  • Kansas City, MO
  • NPI 1528463080

  Member Of

  NPD member

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph V. Cannova Jr., M.D.

  • Plastic and Reconstructive Surgery Physician
  • Leawood, KS
  • NPI 1225037732
  NPD
• David J Clymer, MD

  • Orthopaedic Surgery Physician
  • Overland Park, KS
  • NPI 1235121005
  NPD
• Benyamine Mizrahi, M.D.

  • Colon & Rectal Surgery Physician
  • Overland Park, KS
  • NPI 1902095805
  NPD (past)

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627603200000",
    "number": "1114924685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10730 NALL AVE",
            "address_2": "SUITE 100",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111206",
            "telephone_number": "913-901-9000",
            "fax_number": "913-901-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730 NALL AVE",
            "address_2": "SUITE 100",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111206",
            "telephone_number": "913-901-9000",
            "fax_number": "913-901-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH KANSAS CITY SURGICAL CENTER, LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "913-901-9000",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSN, RN, CNOR"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "KS",
            "license": "S046019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200310690A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Kansas City Surgicenter",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Kansas City Surgicenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Francisco Javier Sosa, DDS
• Hannah Sosa
• Rachel Helene Sosland, MD
• Morgan Souders, APRN
• Megan Sousa, PHARMD
• South Wind Psychiatry LLC (Mile High Psychiatry LLC)
• Jason Southard, LMSW
• Southwind Anesthesia Services, P.a.
• Southwind Medical Supplies LLC
• Southwind Medical Supplies, LLC

• Ambulatory Surgical Clinic/Center in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Ambulatory Surgical Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; 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.