NPIMap

Organization Active NPI

Great Lakes Eye Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Saginaw, MI
National Provider Identifier
1265542849
Registry record updated Oct 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
GREAT LAKES EYE SURGERY CENTER LLC
Practice address
2393 Schust Rd
Saginaw, MI 48603-1334
Phone
(989) 793-2820
Fax
(989) 793-9132
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2007

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

Authorized official

Name
Dr. Farhad K Shokoohi, M.D.NPI 1275526048
Title
Owner
Phone
(989) 793-2820

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 Primary

Addresses

Primary practice location

2393 Schust Rd
Saginaw, MI 48603-1334

Mailing address

2393 Schust Rd
Saginaw, MI 48603-1334
Phone (989) 793-2820

Other identifiers 1

IdentifierTypeStateIssuer
0G31248OtherMIBLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060927000177 MI Part B Supplier - Ambulatory Surgical Center 1759386691 Receives reassigned benefits from 17 practitioners
Practice locations: Saginaw, MI

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Great Lakes Eye Surgery Center LLCCCN 23C0001077
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Eye Anesthesia3 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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192147200000",
    "number": "1265542849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2393 SCHUST RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486031334",
            "telephone_number": "989-793-2820",
            "fax_number": "989-793-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2393 SCHUST RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486031334",
            "telephone_number": "989-793-2820",
            "fax_number": "989-793-9132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES EYE SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-10-12",
        "status": "A",
        "authorized_official_last_name": "SHOKOOHI",
        "authorized_official_first_name": "FARHAD",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-793-2820",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0G31248",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; 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.