Active NPI
Surgery Center at Gateway LLC
- Ambulatory Surgical Clinic/Center
- Flint, MI
National Provider Identifier
1215400320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- Legal business name
- SURGERY CENTER AT GATEWAY LLC
- Practice address
- 5302 Gateway Ctr
Flint, MI 48507-3930 - Phone
- (810) 720-9111
- NPI assigned
- Jan 10, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Edward P Stack, MD
- Title
- Ceo
- Phone
- (810) 720-9111
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Primary |
Addresses
Primary practice location
5302 Gateway Ctr
Flint, MI 48507-3930
Mailing address
5302 Gateway Ctr
Flint, MI 48507-3930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190731003850 | MI | Part B Supplier - Ambulatory Surgical Center | 9133455918 |
1 other NPI on this enrollment Practice locations: Flint, MI |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Surgery Center at Gateway LLC
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
5302 Gateway Ctr
Flint, MI 48507
Phone (810) 285-9901
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547078400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1701820800000",
"number": "1215400320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5302 GATEWAY CTR",
"city": "FLINT",
"state": "MI",
"postal_code": "485073930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5302 GATEWAY CTR",
"city": "FLINT",
"state": "MI",
"postal_code": "485073930",
"telephone_number": "810-720-9111"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SURGERY CENTER AT GATEWAY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-01-10",
"last_updated": "2023-12-06",
"certification_date": "2023-12-06",
"status": "A",
"authorized_official_last_name": "STACK",
"authorized_official_first_name": "EDWARD",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "810-720-9111",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.