Organization Active NPI

Key West Surgical Group Inc

  • Specialist
  • Key West, FL
National Provider Identifier
1215039409
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
KEY WEST SURGICAL GROUP INC
Practice address
3136 Norhtside Drive
Key West, FL 33040-8027
Phone
(305) 294-1041
Fax
(305) 293-0990
NPI assigned
Sep 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ana C Segura-Garcia
Title
Billing-Coding
Phone
(305) 294-1041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X FL Primary

Addresses

Primary practice location

3136 Norhtside Drive
Key West, FL 33040-8027

Mailing address

3136 Norhtside Drive
Key West, FL 33040-8027
Phone (305) 294-1041

Other identifiers 1

IdentifierTypeStateIssuer
255847500MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000169 FL Part B Supplier - Clinic/Group Practice 2860305901 Receives reassigned benefits from 1 practitioner
Practice locations: Key West, FL

National Provider Directory

National Provider Directory

Locations

3136 Northside Dr
Key West, FL 33040
Phone (305) 294-1041

Practitioners & affiliated clinicians

Practitioners 2

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": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1215039409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3136 NORHTSIDE DRIVE",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330408027",
            "telephone_number": "305-294-1041",
            "fax_number": "305-293-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3136 NORHTSIDE DRIVE",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330408027",
            "telephone_number": "305-294-1041",
            "fax_number": "305-293-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEY WEST SURGICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SEGURA-GARCIA",
        "authorized_official_first_name": "ANA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "BILLING-CODING",
        "authorized_official_telephone_number": "305-294-1041"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255847500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Key West, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.