NPIMap

Organization Active NPI

Executive Woods Ambulatory Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Albany, NY
National Provider Identifier
1265495451
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
0101219R Issued in NY
Legal business name
EXECUTIVE WOODS AMBULATORY SURGERY CENTER LLC
Practice address
3 Atrium Dr
Suite 150
Albany, NY 12205-1417
Phone
(518) 453-2361
Fax
(518) 453-1594
NPI assigned
Apr 10, 2006
Last updated
Jul 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Authorized official

Name
Kyle R. Flik, MDNPI 1730156910
Title
Medical Director
Phone
(518) 453-2361

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 0101219R NY Primary

Addresses

Primary practice location

3 Atrium Dr
Suite 150
Albany, NY 12205-1417

Mailing address

3 Atrium Dr
Suite 150
Albany, NY 12205-1417
Phone (518) 453-2361

Other identifiers 5

IdentifierTypeStateIssuer
10043997OtherNYCDPHP PROVIDER NUMBER
1488OtherNYMVP PROVIDER NUMBER
014594OtherNYEMPIRE BC PROVIDER NUMBER
02107211MedicaidNY
000401075000OtherNYBSNENY PROVIDER NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111227000704 NY Part B Supplier - Ambulatory Surgical Center 5597931444 Practice locations: Albany, NY

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Executive Woods Ambulatory Surgery Center LLCCCN 33C0001054
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0974859Executive Woods Ambulatory Surg Ctr LLC3 Atrium Drive - Suite 150, Albany, NY 12205Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3 Atrium Dr
Ste 150
Albany, NY 12205
Phone (518) 453-2361

Practitioners & affiliated clinicians

Practitioners 47

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 47

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753228800000",
    "number": "1265495451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 ATRIUM DR",
            "address_2": "SUITE 150",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051417",
            "telephone_number": "518-453-2361",
            "fax_number": "518-453-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 ATRIUM DR",
            "address_2": "SUITE 150",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051417",
            "telephone_number": "518-453-2361",
            "fax_number": "518-453-1594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE WOODS AMBULATORY SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A",
        "authorized_official_last_name": "FLIK",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "518-453-2361",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NY",
            "license": "0101219R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP PROVIDER NUMBER",
            "identifier": "10043997",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP PROVIDER NUMBER",
            "identifier": "1488",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC PROVIDER NUMBER",
            "identifier": "014594",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02107211",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSNENY  PROVIDER NUMBER",
            "identifier": "000401075000",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; 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.