Willoughby Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

WILLOUGHBY SURGERY CENTER, LLC

Practice address

6025 Commerce Cir
Suite 1
Willoughby, OH 44094-9668

Phone

(440) 585-2750

Fax

(440) 944-0868

NPI assigned

Mar 26, 2008

Organization subpart

No

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

Authorized official

Name

David A Demangone, M.D.NPI 1548225832

Title

Owner

Phone

(440) 944-1414

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Listed as

Willoughby Surgery Center LLCCCN 36C0001256

Medicare certification status

ActiveFrom the Provider of Services file

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

Practitioners 4

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

• David Anthony Demangone, M.D.

  • Pain Medicine Physician
  • Willoughby, OH
  • NPI 1548225832
  NPD (past) Authorized official
• Kristina Lynn Lasko, CRNA

  • Certified Registered Nurse Anesthetist
  • Mentor, OH
  • NPI 1184221731
  NPD (past)
• Rochelle O'Connor, CRNA

  • Certified Registered Nurse Anesthetist
  • Brunswick, OH
  • NPI 1740663152
  NPD (past)
• Boris Vinogradsky, MD

  • Surgery Physician
  • Willoughby, OH
  • NPI 1447220025
  NPD (past)

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

{
    "created_epoch": "1206489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361318400000",
    "number": "1255503553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6025 COMMERCE CIR",
            "address_2": "SUITE 1",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440949668",
            "telephone_number": "440-585-2750",
            "fax_number": "440-944-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 COMMERCE CIR",
            "address_2": "SUITE 1",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440949668",
            "telephone_number": "440-585-2750",
            "fax_number": "440-944-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOUGHBY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-26",
        "last_updated": "2013-02-20",
        "status": "A",
        "authorized_official_last_name": "DEMANGONE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-944-1414",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00829745",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3137920",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Williams
• Willoughby Al Operations, LLC
• Willoughby ASC LLC
• Willoughby Chiropractic Center, Inc.
• Willoughby SNF Healthcare LLC
• Willoughby Therapy Inc
• Willoughby-Eastlake City SD
• Stella M Willoughby
• Amelia Ann Wilmot
• Gina Wilms, RN

• Ambulatory Surgical Clinic/Center in Willoughby, OH
• Providers in Willoughby, OH by specialty
• Ambulatory Surgical Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; 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.