Apollo Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

APOLLO SURGICAL CENTER LLC

Practice address

7615 E Baseline Rd Ste 102
Mesa, AZ 85209-2000

Phone

(480) 597-3290

NPI assigned

Nov 2, 2022

Last updated

Apr 12, 2024By 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

Fawn Boonstra

Title

Office Manager

Phone

(480) 286-7907

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225745870. Details of each certification follow.

• CCN 03C0001483 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 03C0001483

Legal name

APOLLO SURGICAL CENTER LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Oct 27, 2023

Last certification

Oct 27, 2023

Ownership / control type

Proprietary

Facility address

7615 E Baseline Road Ste 102
Mesa, AZ 85209

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712880000000",
    "number": "1225745870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7615 E BASELINE RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852092000",
            "telephone_number": "480-597-3290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7615 E BASELINE RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852092000",
            "telephone_number": "480-597-3290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APOLLO SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-02",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A",
        "authorized_official_last_name": "BOONSTRA",
        "authorized_official_first_name": "FAWN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "480-286-7907"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Apothecary Shop of Mesa Inc (The Apothecary Shop of Mesa)
• Lacey Appachu, NP
• Edward Joseph Appiah Boateng

• Ambulatory Surgical Clinic/Center in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; 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.