NPIMap

Organization Active NPI

Pacific Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Eugene, OR
National Provider Identifier
1225042575
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
1524 Issued in OR
Legal business name
PACIFIC SURGERY CENTER LLC
Practice address
1125 Darlene LN
Suite 201
Eugene, OR 97401-1601
Phone
(541) 683-5488
Fax
(541) 683-7224
NPI assigned
Jul 29, 2006
Last updated
Jun 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Authorized official

Name
Mr. James H Cobb, JR.
Title
Manager
Phone
(541) 431-0665

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 1524 OR Primary
Anesthesiology Physician 207L00000X NU

Addresses

Primary practice location

1125 Darlene LN
Suite 201
Eugene, OR 97401-1601

Mailing address

1125 Darlene LN Ste 201
Eugene, OR 97401-1601
Phone (541) 683-5488

Other identifiers 1

IdentifierTypeStateIssuer
167491MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100217000861 OR Part B Supplier - Ambulatory Surgical Center 6406990241 Receives reassigned benefits from 12 practitioners
Practice locations: Eugene, OR

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Pacific Surgery CenterCCN 38C0001034
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0969113Pacific Surgery Center1125 Darlene Lane, Eugene, OR 97401Certificate of waiverJan 3, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1225042575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 DARLENE LN STE 201",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974011601",
            "telephone_number": "541-683-5488",
            "fax_number": "541-683-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 DARLENE LN",
            "address_2": "SUITE 201",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974011601",
            "telephone_number": "541-683-5488",
            "fax_number": "541-683-7224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "COBB",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "541-431-0665",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JR."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OR",
            "license": "1524",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167491",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.