NPIMap

Organization Active NPI

University Surgery Center LLC

Doing business as Mallard Creek Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Charlotte, NC
National Provider Identifier
1144652330
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
00000 Issued in NC
Legal business name
UNIVERSITY SURGERY CENTER LLC
Doing business as
Mallard Creek Surgery Center
Practice address
9848 N Tryon St
Suite 200
Charlotte, NC 28262-5512
Phone
(704) 548-5200
Fax
(704) 323-3933
NPI assigned
Jul 30, 2013
Last updated
Nov 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2023

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

Authorized official

Name
Brent Shear
Title
Cfo
Phone
(704) 323-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 00000 NC Primary

Addresses

Primary practice location

9848 N Tryon St
Suite 200
Charlotte, NC 28262-5512

Mailing address

PO Box 117444
Atlanta, GA 30368-7444
Phone (704) 323-2000

Other names 1

  • Mallard Creek Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140520002334 NC Part B Supplier - Ambulatory Surgical Center 1759504772 Practice locations: Charlotte, NC

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Mallard Creek Surgery CenterCCN 34C0001191
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2073016University Surgery Center, LLC9848 North Tryon Street, Charlotte, NC 28262Certificate of waiverFeb 9, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1375142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699574400000",
    "number": "1144652330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 117444",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303687444",
            "telephone_number": "704-323-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9848 N TRYON ST",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282625512",
            "telephone_number": "704-548-5200",
            "fax_number": "704-323-3933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-30",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A",
        "authorized_official_last_name": "SHEAR",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "704-323-2222"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": "00000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mallard Creek Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mallard Creek Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; 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.