Medical and Dental Center of Nevada LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MEDICAL AND DENTAL CENTER OF NEVADA LLC

Practice address

4275 Burnham Ave Ste 101
Las Vegas, NV 89119-5400

Phone

(702) 489-3555

NPI assigned

Jun 6, 2018

Last updated

Dec 11, 2023By 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

Devin Larsen

Title

Ceo

Phone

(208) 340-1840

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215429030. Details of each certification follow.

• CCN 29C0001120 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 29C0001120

Legal name

MEDICAL AND DENTAL CENTER OF NEVADA, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jan 29, 2019

Last certification

Jan 29, 2019

Ownership / control type

Proprietary

Facility address

4275 Burnham Avenue, #101
Las Vegas, NV 89119

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

CLIA laboratory certificates

Practitioners 1

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.

• Dodd Hyer, MD

  • Anesthesiology Physician
  • Las Vegas, NV
  • NPI 1720064124
  NPD (past)

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702252800000",
    "number": "1215429030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4275 BURNHAM AVE STE 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891195400",
            "telephone_number": "702-489-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4275 BURNHAM AVE STE 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891195400",
            "telephone_number": "702-489-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL AND DENTAL CENTER OF NEVADA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-06",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-340-1840"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Ambulatory Surgical Clinic/Center in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.