Surgical Specialty Center of Northeastern Pennsylvania, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

148601 Issued in PA

Legal business name

SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC

Practice address

190 Welles St
Forty Fort, PA 18704-4968

Phone

(570) 331-7615

Fax

(570) 331-7614

NPI assigned

May 23, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Snodgrass

Title

President

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Listed as

Surgical Specialty CenterCCN 39C0001112

Medicare certification status

ActiveFrom the Provider of Services file

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Forty Fort Anesthesia Associates LLC

  • Certified Registered Nurse Anesthetist
  • Forty Fort, PA
  • NPI 1346600038

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Louis C Blaum, MD

  • Surgery Physician
  • Wilkes Barre, PA
  • NPI 1669420675
  NPD (past)

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670976000000",
    "number": "1245233410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1A BURTON HILLS BLVD # L&C",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156187",
            "telephone_number": "615-240-3820",
            "fax_number": "615-234-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 WELLES ST",
            "city": "FORTY FORT",
            "state": "PA",
            "postal_code": "187044968",
            "telephone_number": "570-331-7615",
            "fax_number": "570-331-7614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "SNODGRASS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "148601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH PRO",
            "identifier": "814135",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MED PLUS/3 RIVERS PROVIDE",
            "identifier": "127866",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2139542",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "991073",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH PROVIDER #",
            "identifier": "077861",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FREEDOM BLUE",
            "identifier": "0198",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "49005260",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD PROVIDER #",
            "identifier": "A2738987",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER PROVIDER #",
            "identifier": "68929",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET PROVIDER #",
            "identifier": "IY0345",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018825790001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "2670019",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sleep Disorders Center of Wyoming Valley, LLC
• Erica Lynne Sorber-Daub
• Laura Elizabeth Stempien, LBS
• Stephen M. Lawrence ,DMD, P.C.
• Kimberly Stokes, LPC
• Kaitlin Jane Mausteller Sutliff, AU.D, CCC-A
• Andrew T Turrisi III, MD
• Valley ENT, P.C.
• Joseph P Vavrek, HEARING AID FITTER
• Allyson Nichole Villella

• Ambulatory Surgical Clinic/Center in Forty Fort, PA
• Providers in Forty Fort, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.