West Suburban Eye Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

AIIY Issued in MA

Legal business name

WEST SUBURBAN EYE SURGERY CENTER LLC

Doing business as

Surgisite North

Practice address

321 Billerica Rd
Chelmsford, MA 01824-4169

Phone

(978) 614-0510

Fax

(781) 891-9305

NPI assigned

Oct 13, 2016

Last updated

Mar 9, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Evan Gold, M.D.NPI 1760441034

Title

Medical Director

Phone

(781) 891-9300

Specialties & licenses 1

Addresses

Other names 1

• Surgisite North Doing business as

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• West Suburban Eye Surgery Center LLC

  dba Surgisite Boston

  • Ophthalmologic Surgery Clinic/Center
  • Waltham, MA
  • NPI 1770537227

  7113939687

  Same PAC ID

Listed as

West Suburban Eye Surgery Center LLCCCN 22C0001080

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Tax ID family

Surgisite Boston2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• West Suburban Eye Surgery Center LLC

  dba Surgisite Boston

  • Ophthalmologic Surgery Clinic/Center
  • Waltham, MA
  • NPI 1770537227
  NPD tax ID

Member of 1

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

• Pratt Ophthalmology Associates Inc

  • Ophthalmology Physician
  • Boston, MA
  • NPI 1083660534

  Member Of

  NPD member

Locations

Practitioners 2

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.

• Evan Bruce Gold, M.D.

  • Ophthalmology Physician
  • Needham, MA
  • NPI 1760441034
  NPD Authorized official
• Jonathan H Talamo, MD

  • Ophthalmology Physician
  • Waltham, MA
  • NPI 1942292560
  NPD (past)

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

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489017600000",
    "number": "1194275230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 BILLERICA RD",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018244169",
            "telephone_number": "978-614-0510",
            "fax_number": "978-614-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 BILLERICA RD",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018244169",
            "telephone_number": "978-614-0510",
            "fax_number": "781-891-9305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SUBURBAN EYE SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-13",
        "last_updated": "2017-03-09",
        "status": "A",
        "authorized_official_last_name": "GOLD",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "781-891-9300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MA",
            "license": "AIIY",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgisite North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christina L Wei, M.D.
• Krystal Ann Welch
• Wellness Counseling PLLC (Ellie Mental Health)
• Wellworth Homecare Services Inc.
• Emily Welsh, PMHNP-BC
• Gatewood West, LICSW
• Nathan Wetzelberg, DPT
• Mary-Ellen Wildman, LMHC
• Jenna Michelle Willard, O.D.
• William J. Lewis, DDS, Inc.

• Ambulatory Surgical Clinic/Center in Chelmsford, MA
• Providers in Chelmsford, MA by specialty
• Ambulatory Surgical Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; 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.