NPIMap

Organization Active NPI

Southwest Medical Associates Inc.

  • Ambulatory Surgical Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1174607303
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
29C0001000 Issued in NV
Legal business name
SOUTHWEST MEDICAL ASSOCIATES INC.
Practice address
2450 W Charleston Blvd
Las Vegas, NV 89102-2179
Phone
(702) 877-8660
Fax
(702) 258-1322
NPI assigned
Oct 24, 2006
Reactivated
Mar 27, 2019
Last updated
Jan 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Authorized official

Name
Emily Castillo
Title
Medical Staff Manager
Phone
(702) 480-2550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 29C0001000 NV Primary

Addresses

Primary practice location

2450 W Charleston Blvd
Las Vegas, NV 89102-2179

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other identifiers 1

IdentifierTypeStateIssuer
004602868MedicaidNV

Other names 1

  • Southwest Surgical Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205001053 NV Part B Supplier - Ambulatory Surgical Center 6103730544 Receives reassigned benefits from 1 practitioner
Practice locations: Las Vegas, NV

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Southwest Medical Associates IncCCN 29C0001000
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
29D0904177Southwest Medical Assoc/Ambulatory Surgery Ctr2450 W Charleston Blvd, Las Vegas, NV 89102Certificate of waiverAug 8, 2027

National Provider Directory

National Provider Directory

Locations

10040 Alta Dr
Ste 210
Las Vegas, NV 89145
Phone (702) 589-9250

Practitioners & affiliated clinicians

Practitioners 70

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.

View all 70

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1174607303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022179",
            "telephone_number": "702-877-8660",
            "fax_number": "702-258-1322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MEDICAL ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "deactivation_date": "2019-03-04",
        "reactivation_date": "2019-03-27",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "MEDICAL STAFF MANAGER",
        "authorized_official_telephone_number": "702-480-2550"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NV",
            "license": "29C0001000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004602868",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Surgical Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Southwest Surgical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

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