The Outpatient Surgery Center of Cedar Rapids, LLC

Key facts

NPI

1124022595

Entity type

Organization (NPI type 2)

Primary specialty

Ambulatory Surgical Clinic/Center 261QA1903X

Legal business name

THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS, LLC

Practice address

1075 1St Avenue SE
Cedar Rapids, IA 52402

Phone

(319) 558-4800

Fax

(319) 558-4806

NPI assigned

Jun 13, 2005

Organization subpart

No

Authorized official

Name

Kallemeyn Scott

Title

Executive Director

Phone

(319) 558-4801

Member of 3

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

• Physicians' Clinic of Iowa, PC Surgery Physician · Cedar Rapids, IA · NPI 1821075599
  NPD member Member Of
• St Luke'S Methodist Hospital Psychiatric Hospital Unit · Cedar Rapids, IA · NPI 1356433015
  NPD member Member Of
• St. Luke'S Jones Regional Medical Center Emergency Medicine Physician · Anamosa, IA · NPI 1942397328
  NPD member Member Of

Practitioners 2

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

• Thomas Allen Simpson, M.D. Otolaryngology/Facial Plastic Surgery Physician · Iowa City, IA · NPI 1285672428
  NPD
• Gregory Rex Hill, MD Orthopaedic Surgery Physician · Fort Dodge, IA · NPI 1457322745
  NPD (past)

Medicare Care Compare: Ambulatory surgical center

Listed as

Surgery Center Cedar Rapids CCN 16C0001016

Medicare certification status

Active (Provider of Services file)

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IA

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Surgery Center Cedar Rapids Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 2, 2019.

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546387200000",
    "number": "1124022595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 1ST AVENUE SE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "52402",
            "telephone_number": "319-558-4802",
            "fax_number": "319-558-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 1ST AVENUE SE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "52402",
            "telephone_number": "319-558-4800",
            "fax_number": "319-558-4806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2019-01-02",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "KALLEMEYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "319-558-4801"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0610238",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK-BC/BS ID NUMBER",
            "identifier": "61016",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgery Center Cedar Rapids",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Surgery Center Cedar Rapids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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All providers in Cedar Rapids, IA · Ambulatory Surgical Clinic/Center in Iowa