Eye Surgery Center of Southern California, a Medical Group

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

A85939 Issued in CA

Legal business name

EYE SURGERY CENTER OF SOUTHERN CALIFORNIA, A MEDICAL GROUP

Doing business as

Tri City Surgery Center

Practice address

2023 W Vista Way
Suite E
Vista, CA 92083-6030

Phone

(760) 941-8152

NPI assigned

Aug 22, 2013

Last updated

Aug 26, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

EYE SURGERY CENTER OF SOUTHERN CALIFORNIA, A MEDICAL GROUPAs reported in NPPES

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

Authorized official

Name

Dr. Anuj Gupta, M.D.NPI 1073629549

Title

Medical Director

Phone

(760) 941-8152

Specialties & licenses 1

Addresses

Other names 1

• Tri City Surgery Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285068536. Details of each certification follow.

• CCN 05C0001020 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 05C0001020

Legal name

EYE SURGERY CENTER OF SOUTHERN CALIFORNIA, INC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Nov 12, 1983

Last certification

Nov 9, 2018

Ownership / control type

Proprietary

Facility address

2023 W Vista Way #E
Vista, CA 92083

Part of

Eye Surgery Ctr of So Calif

Practitioners 1

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.

• Anuj Gupta, MD

  • Interventional Pain Medicine Physician
  • Vista, CA
  • NPI 1073629549
  Authorized official Same address or phone

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

{
    "created_epoch": "1377129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377475200000",
    "number": "1285068536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR",
            "address_2": "SUITE 301",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771726",
            "telephone_number": "310-943-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 W VISTA WAY",
            "address_2": "SUITE E",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836030",
            "telephone_number": "760-941-8152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SURGERY CENTER OF SOUTHERN CALIFORNIA, A MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EYE SURGERY CENTER OF SOUTHERN CALIFORNIA, A MEDICAL GROUP",
        "enumeration_date": "2013-08-22",
        "last_updated": "2013-08-26",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "ANUJ",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "760-941-8152",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A85939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri City Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eye Surgery Ctr of So Calif a Med Group (Tri-City Surgery Center)
• Maisaa Fadul
• Linda S Falconio MD, MD
• Jessica Farber
• Tiffany Farber

• Non-Pharmacy Dispensing Site in Vista, CA
• Providers in Vista, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.