Granite Bay Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GRANITE BAY SURGERY CENTER, LLC

Practice address

8723 Sierra College Blvd #1
Roseville, CA 95661

Phone

(916) 773-5559

NPI assigned

Dec 5, 2016

Last updated

Aug 28, 2018By 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

Joseph Rudy Coscia, M.D.NPI 1982861753

Title

Partner

Phone

(916) 929-1833

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245774611. Details of each certification follow.

• CCN 05C0002245 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 05C0002245

Legal name

GRANITE BAY SURGERY CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Mar 8, 2019

Last certification

Mar 8, 2019

Ownership / control type

Proprietary

Facility address

8723 Sierra College Blvd
Roseville, CA 95661

Locations

Practitioners 3

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.

• Joseph R. Coscia, MD

  • Plastic Surgery Physician
  • Sacramento, CA
  • NPI 1982861753
  NPD Authorized official
• Scott Douglas Green, M.D.

  • Plastic Surgery Physician
  • Sacramento, CA
  • NPI 1326110347
  NPD
• Wayne Ichiro Yamahata, M.D.

  • Plastic Surgery Physician
  • Sacramento, CA
  • NPI 1942375233
  NPD

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

{
    "created_epoch": "1480896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535414400000",
    "number": "1245774611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8723 SIERRA COLLEGE BLVD. BUILDING 1.",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "95746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8723 SIERRA COLLEGE BLVD #1",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95661",
            "telephone_number": "916-773-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE BAY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-05",
        "last_updated": "2018-08-28",
        "status": "A",
        "authorized_official_last_name": "COSCIA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "RUDY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "916-929-1833",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Graham, BS SLPA
• Kevin Gramyk, MD
• Granger B Wong M D Inc
• Danielle N Granieri, D.O.
• Jocelyn Marlen Granillo Gallegos
• Granite Pointe Eye Care, Inc., an Optometric Corporation (Foothills Optometry)
• Granite Pointe Eye Care, Inc., an Optometric Corporation
• Granite Spring Care Home I Inc
• Granite Wellness Centers (Roseville Campus)
• Aundrea Louise Grant, FNP

• Ambulatory Surgical Clinic/Center in Roseville, CA
• Providers in Roseville, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.