East West Laser and Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EAST WEST LASER AND AMBULATORY SURGERY CENTER, LLC

Practice address

1855 East-West Parkway
Suite 1
Fleming Island, FL 32003

Phone

(561) 630-6277

Fax

(561) 630-6062

NPI assigned

Jul 29, 2021

Last updated

Jul 29, 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

Dr. Russell A. Pecoraro, M.D.NPI 1891887394

Title

Manager

Phone

(904) 272-2020

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

East West Laser and Ambulatory Surgery Center LLCCCN 10C0001711

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 2

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.

• Russell Anthony Pecoraro, MD

  • Ophthalmology Physician
  • Orange Park, FL
  • NPI 1891887394
  Authorized official Same address or phone
• David W Hayes, D.O.

  • Ophthalmology Physician
  • Orange Park, FL
  • NPI 1659357010
  NPD (past)

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627516800000",
    "number": "1225701824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 EAST-WEST PARKWAY",
            "address_2": "SUITE 1",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "32003",
            "telephone_number": "561-630-6277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 EAST-WEST PARKWAY",
            "address_2": "SUITE 1",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "32003",
            "telephone_number": "561-630-6277",
            "fax_number": "561-630-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST WEST LASER AND AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "PECORARO",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-272-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EWLASC",
            "affiliation": "N",
            "address_1": "1855 East-West Parkway",
            "address_2": "Suite 1",
            "city": "Fleming Island",
            "state": "FL",
            "country_code": "US",
            "postal_code": "32003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew James Drake
• Laura Arrison Dunton, ARNP
• Michael Edward Dutton
• Jessica Dyer, PT
• East West Anesthesia LLC
• Christina Eaton, RBT
• Firas El Sabbagh, MD
• Elite Stairs ,Rails, & Trimwork Inc (Assist Therapy)
• Emdr Trauma Therapy Center LLC
• Emergency Physicians Inc (Emergency Resources Group)

• Ambulatory Surgical Clinic/Center in Fleming Island, FL
• Providers in Fleming Island, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

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