Hyde Park Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

036130154 Issued in IL

Legal business name

HYDE PARK SURGICAL CENTER LLC

Practice address

1644 E 53Rd St
Chicago, IL 60615-4210

Phone

(773) 752-6340

Fax

(773) 752-6368

NPI assigned

May 11, 2015

Last updated

Aug 11, 2021By 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

Melissa Rice

Title

Adminsitrator

Phone

(773) 752-6340

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Hyde Park Surgical Center Dba Hyde Park Same Day SurgicenterCCN 14C0001114

Listed as

Hyde Park Surgical Center LLCCCN 14C0001116

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

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628640000000",
    "number": "1205214103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1644 E 53RD STREET",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154210",
            "telephone_number": "773-752-6340",
            "fax_number": "773-752-6368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1644 E 53RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154210",
            "telephone_number": "773-752-6340",
            "fax_number": "773-752-6368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HYDE PARK SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "last_updated": "2021-08-11",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "ADMINSITRATOR",
        "authorized_official_telephone_number": "773-752-6340"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "036130154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; 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.