Organization Active NPI

Everett Road ASC, LLC

  • Ambulatory Surgical Clinic/Center
  • Albany, NY
National Provider Identifier
1164083911
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
EVERETT ROAD ASC, LLC
Practice address
123 Everett Rd
Albany, NY 12205-1407
Phone
(518) 489-2663
Fax
(518) 689-3881
NPI assigned
Jun 24, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Authorized official

Name
Frank Congiusta, MDNPI 1245280403
Title
Medical Director
Phone
(518) 453-9088

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

123 Everett Rd
Albany, NY 12205-1407

Mailing address

121 Everett Rd
Albany, NY 12205-1474
Phone (518) 489-2663

Other identifiers 1

IdentifierTypeStateIssuer
06200059MedicaidNY

Other names 1

  • Everett Road Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200109000572 NY Part B Supplier - Ambulatory Surgical Center 0648605204 Practice locations: Albany, NY

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Everett Rd Surgery CenterCCN 33C0001186
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
33D2172394Everett Road Surgery Center123 Everett Road - 2ND Floor, Albany, NY 12205Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Member of 2

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

Locations

123 Everett Rd
Albany, NY 12205
Phone (518) 701-2000

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753228800000",
    "number": "1164083911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 EVERETT RD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051474",
            "telephone_number": "518-489-2663",
            "fax_number": "518-689-3881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 EVERETT RD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051407",
            "telephone_number": "518-489-2663",
            "fax_number": "518-689-3881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERETT ROAD ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A",
        "authorized_official_last_name": "CONGIUSTA",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "518-453-9088",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06200059",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Everett Road Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Everett Road Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; 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.