Riverside Surgical Center,LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

RIVERSIDE SURGICAL CENTER,LLC

Practice address

7207 Golden Wings Road
Suite 200
Jacksonville, FL 32244-0000

Phone

(866) 631-7890

NPI assigned

Mar 2, 2009

Organization subpart

No

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

Authorized official

Name

Jennifer Boyd Baldock

Title

Officer and Authorized Official

Phone

(615) 234-5900

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Riverside Surgical CenterllcCCN 10C0001541

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Riverside Surgical Center2 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.

• Riverside Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Jacksonville, FL
  • NPI 1548594880
  NPD tax ID

Locations

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

{
    "created_epoch": "1235952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581033600000",
    "number": "1265672356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7207 GOLDEN WINGS ROAD",
            "address_2": "SUITE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322440000",
            "telephone_number": "866-631-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7207 GOLDEN WINGS ROAD",
            "address_2": "SUITE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322440000",
            "telephone_number": "866-631-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE SURGICAL CENTER,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-02",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5900"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Riverside Spine & Pain Physicians, LLC
• Riverside Spine & Pain Physicians, LLC
• Riverside Spine & Pain Physicians, LLC
• Riverside Spine & Pain Physicians, LLC
• Riverside Surgical Center
• Riverwood Center, LLC
• Riverwood Nursing Center LLC
• Ethan Christoper Rivest
• Carmen Daniela Riza, ARNP
• Albert Glenn Rizer, D.S.W.

• Ambulatory Surgical Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; 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.