NPIMap

Organization Active NPI

Surgical Specialists of St Lucie

Doing business as Blue Water Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Port St Lucie, FL
National Provider Identifier
1164719209
Registry record updated Jun 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
1570 Issued in FL
Legal business name
SURGICAL SPECIALISTS OF ST LUCIE
Doing business as
Blue Water Surgery Center
Practice address
6830 S US Highway 1
Port St Lucie, FL 34952-1410
Phone
(772) 873-6700
Fax
(772) 465-5499
NPI assigned
Jul 8, 2011
Last updated
Jun 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2023

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

Authorized official

Name
Allen Licht
Title
Managing Director
Phone
(954) 906-9536

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 1570 FL Primary

Addresses

Primary practice location

6830 S US Highway 1
Port St Lucie, FL 34952-1410

Mailing address

12350 NW 39TH St Ste 200
Coral Springs, FL 33065-2414
Phone (954) 248-3422

Other names 1

  • Blue Water Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164719209. Details of each certification follow.

Hospital certification: CCN 100332

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BLUE WATER SURGERY CENTER
Certification status
Terminated Voluntary: merger or closure, Apr 23, 2020
Provider type (POS)
Hospital – Short-term
Participating since
Mar 27, 2020
Last certification
Mar 27, 2020
Beds
1
Ownership / control type
Private (for profit)
Facility address
6830 S US Highway 1
Port Saint Lucie, FL 34952

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Surgical Specialistsd of Saint Lucie County LLCCCN 10C0001570
Medicare certification status
Terminated Voluntary: merger or closure, Jun 1, 2024From the Provider of Services file

National Provider Directory

National Provider Directory

Locations

6830 S US Highway 1
#C
Port St Lucie, FL 34952
Phone (772) 873-6700

Practitioners & affiliated clinicians

Practitioners 3

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": "1310083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686873600000",
    "number": "1164719209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12350 NW 39TH ST STE 200",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330652414",
            "telephone_number": "954-248-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6830 S US HIGHWAY 1",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349521410",
            "telephone_number": "772-873-6700",
            "fax_number": "772-465-5499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL SPECIALISTS OF ST LUCIE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-08",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A",
        "authorized_official_last_name": "LICHT",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "954-906-9536"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Water Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Water Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.