NPIMap

Organization Active NPI

Surgical Center of Greensboro, LLC

  • Ambulatory Surgical Clinic/Center
  • Greensboro, NC
National Provider Identifier
1245288257
Registry record updated Jan 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
AS0018 Issued in NC
Legal business name
SURGICAL CENTER OF GREENSBORO, LLC
Practice address
705 Green Valley Rd
Greensboro, NC 27408-7019
Phone
(336) 272-0012
Fax
(336) 272-4063
NPI assigned
May 4, 2006
Last updated
Jan 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2019

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

Authorized official

Name
Jennifer Graham Jr.
Title
Chief Administrative Officer
Phone
(336) 272-0012

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X AS0018 NC Primary

Addresses

Primary practice location

705 Green Valley Rd
Greensboro, NC 27408-7019

Mailing address

705 Green Valley Rd
Greensboro, NC 27408-7019
Phone (336) 272-0012

Other practice location 1

1211 Virginia St
Greensboro, NC 27401-1313
Phone (336) 272-0012

Other identifiers 1

IdentifierTypeStateIssuer
3409924MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050106000263 NC Part B Supplier - Ambulatory Surgical Center 5890743876 Practice locations: Greensboro, NC

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Surical Center of Greensboro LLCCCN 34C0001008
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Surgical Center of Greensboro LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548288000000",
    "number": "1245288257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 GREEN VALLEY RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087019",
            "telephone_number": "336-272-0012",
            "fax_number": "336-272-4063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 GREEN VALLEY RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087019",
            "telephone_number": "336-272-0012",
            "fax_number": "336-272-4063"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1211 Virginia St",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274011313",
            "country_code": "US",
            "telephone_number": "336-272-0012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SURGICAL CENTER OF GREENSBORO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2019-01-24",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "336-272-0012",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": "AS0018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409924",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; 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.