NPIMap

Organization Active NPI

Urology ASC- Phoenix, LLC

Doing business as Urologic Surgery Center of Arizona

  • Ambulatory Surgical Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1275198673
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
UROLOGY ASC- PHOENIX, LLC
Doing business as
Urologic Surgery Center of Arizona
Practice address
1313 E Osborn Rd Ste 170B
Phoenix, AZ 85014-5678
Phone
(602) 264-4431
Fax
(602) 266-3870
NPI assigned
May 1, 2019
Last updated
Oct 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Authorized official

Name
Eric Boon
Title
Officer/Authorized Official
Phone
(480) 567-0269

Specialties & licenses 1

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

Addresses

Primary practice location

1313 E Osborn Rd Ste 170B
Phoenix, AZ 85014-5678

Mailing address

14201 Dallas Pkwy
Dallas, TX 75254-2916
Phone (469) 872-4706

Other names 1

  • Urologic Surgery Center of Arizona Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201109000746 AZ Part B Supplier - Ambulatory Surgical Center 5799195459 Practice locations: Phoenix, AZ

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Urology ASC Phoenix Dba Urologic Surgery Center of ArizonaCCN 03C0001434
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
03D2172571Urology ASC - Phoenix, LLC1313 E Osborn Road Suite 170, Phoenix, AZ 85014Certificate of waiverSep 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Urology ASC- Phoenix LLC3 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.

Member of 2

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

Locations

1313 E Osborn Rd
Ste 140
Phoenix, AZ 85014

1313 E Osborn Rd
Ste 170
Phoenix, AZ 85014
Phone (602) 264-5455

1313 E Osborn Rd
Ste 170B
Phoenix, AZ 85014
Phone (602) 264-4431

1313 E Osborn Rd
Ste B179
Phoenix, AZ 85014

77 E Thomas Rd
Ste 23
Phoenix, AZ 85012

17300 N Perimeter Dr
Ste 220
Scottsdale, AZ 85255
Phone (480) 661-2661

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1275198673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14201 DALLAS PKWY",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752542916",
            "telephone_number": "469-872-4706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 E OSBORN RD STE 170B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850145678",
            "telephone_number": "602-264-4431",
            "fax_number": "602-266-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY ASC- PHOENIX, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-01",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Urologic Surgery Center of Arizona",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.