NPIMap

Organization Active NPI

KS SC LLC

  • Ambulatory Surgical Clinic/Center
  • Houston, TX
National Provider Identifier
1144977026
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
KS SC LLC
Practice address
9110 Katy Freeway
Houston, TX 77055-7407
Phone
(713) 442-5669
NPI assigned
Mar 9, 2022
Organization subpart
Yes
Parent organization
KELSEY-SEYBOLD MEDICAL GROUP, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Authorized official

Name
Julie Burch Garcia
Title
Sr Director, Revenue Cycle MGMT
Phone
(713) 442-5027

Specialties & licenses 1

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

Addresses

Primary practice location

9110 Katy Freeway
Houston, TX 77055-7407

Mailing address

11511 Shadow Creek Pkwy
Central Business Office (ASC)
Pearland, TX 77584-7298
Phone (713) 442-5669

Other names 1

  • Kelsey Seybold ASC Memorial Villages Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221010001314 TX Part B Supplier - Ambulatory Surgical Center 7214351691 Practice locations: Houston, TX

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
KS SC LLC Dba Kelsey Seybold ASC Memorial VillagesCCN 45C0451265
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
45D0685116Kelsey-Seybold Clinic Memorial Villages9110 Katy Freeway, Houston, TX 77055RegistrationFeb 10, 2028
45D2262684Kelsey-Seybold Clinic Memorial Villages9110 Katy Freeway, Houston, TX 77055Certificate of waiverJun 15, 2028
45D2264730Kelsey-Seybold Clinics/Memorial Villages Lab9110 Katy Freeway, Houston, TX 77055RegistrationJan 4, 2028
45D2268219Kelsey-Seybold Clinic Memorial Villages ASC9110 Katy Freeway, Houston, TX 77055ComplianceJun 26, 2028

National Provider Directory

National Provider Directory
Tax ID family
KS SC LLC5 organizations share this tax ID, including this one
Part of
Kelsey Seybold Med GRP PLLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1144977026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 SHADOW CREEK PKWY",
            "address_2": "CENTRAL BUSINESS OFFICE (ASC)",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775847298",
            "telephone_number": "713-442-5669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9110 KATY FREEWAY",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770557407",
            "telephone_number": "713-442-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KS SC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KELSEY-SEYBOLD MEDICAL GROUP, PLLC",
        "enumeration_date": "2022-03-09",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "BURCH",
        "authorized_official_title_or_position": "SR DIRECTOR, REVENUE CYCLE MGMT",
        "authorized_official_telephone_number": "713-442-5027"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelsey Seybold ASC Memorial Villages",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.