Bismarck Surgical Associates, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BISMARCK SURGICAL ASSOCIATES, LLC

Practice address

106 E Greenfield LN
Bismarck, ND 58503-6578

Phone

(701) 221-2299

Fax

(701) 323-3388

NPI assigned

Jul 11, 2005

Last updated

Oct 24, 2019By 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. Attas Boutrous, MDA

Title

Administrator

Phone

(701) 221-2299

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Bismarck Surgical Associates LLC

  • Certified Registered Nurse Anesthetist
  • Bismarck, ND
  • NPI 1487814356

  6800855099

  Same PAC ID

Listed as

Bismarck Surgical Associates LLCCCN 35C0001015

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Bismarck Surgical Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Bismarck Surgical Associates LLC

  • Certified Registered Nurse Anesthetist
  • Bismarck, ND
  • NPI 1487814356
  NPD tax ID

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.

• Chad Blake Carlson, MD

  • Orthopaedic Surgery Physician
  • Bismarck, ND
  • NPI 1588873186
  Medicare reassignment NPD
• Brandi L Bear, CRNA

  • Certified Registered Nurse Anesthetist
  • Bismarck, ND
  • NPI 1538348529
  NPD (past)

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571875200000",
    "number": "1255339628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 E GREENFIELD LN",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585036578",
            "telephone_number": "701-221-2299",
            "fax_number": "701-323-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E GREENFIELD LN",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585036578",
            "telephone_number": "701-221-2299",
            "fax_number": "701-323-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BISMARCK SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2019-10-24",
        "status": "A",
        "authorized_official_last_name": "BOUTROUS",
        "authorized_official_first_name": "ATTAS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "701-221-2299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MDA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "ND",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10864",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490004061",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8618",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1462920",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5490260",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bismarck Radiology Associates PC
• Bismarck Sinus Center
• Bismarck Sports and Spine, PLLC (Bismarck Sports and Spine)
• Bismarck State College
• Bismarck Surgical Associates LLC
• Bismarck Transportation Services
• Kaitlin Bitterman, LBSW
• Cheryle K Bitz, MSN, ARNP, GNP-BC
• John Bitz
• Mark Tucker Bjelland

• Ambulatory Surgical Clinic/Center in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Ambulatory Surgical Clinic/Center in North Dakota

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