River Park ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

128 Issued in LA

Legal business name

RIVER PARK ASC LLC

Practice address

107 Front St
Ste.1100
Vidalia, LA 71373-2836

Phone

(318) 336-2218

NPI assigned

Sep 27, 2005

Organization subpart

No

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

Authorized official

Name

Marci McGraw

Title

Ceo

Phone

(318) 336-2225

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Listed as

Riverpark Ambulatory Surgery CenterCCN 19C0001091

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

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

• Natchez Hospital Company LLC

  • General Acute Care Hospital
  • Natchez, MS
  • NPI 1164821559

  Member Of

  NPD member

Practitioners 1

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

• Deana Kay Patterson, CFNP

  • Family Nurse Practitioner
  • Ferriday, LA
  • NPI 1952615692
  NPD (past)

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1144216847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "address_2": "STE.1100",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713732836",
            "telephone_number": "318-336-2218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "address_2": "STE.1100",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713732836",
            "telephone_number": "318-336-2218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER PARK ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "MCGRAW",
        "authorized_official_first_name": "MARCI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-336-2225"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "LA",
            "license": "128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03027576",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "190020258Z",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1464015",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Profit
• Leketa Queen, RSW
• RCG Mississippi, Inc.
• Monique Reeed
• Reeves Drug Store Inc
• Riverfront Urgent Care Center LLC
• Riverpark After Hours Clinic LLC
• Riverpark Community Cath Lab, LLC
• Riverpark Counseling LLC
• Riverpark Imaging Center LLC

• Ambulatory Surgical Clinic/Center in Vidalia, LA
• Providers in Vidalia, LA by specialty
• Ambulatory Surgical Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; 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.