Jonesboro Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

JONESBORO AMBULATORY SURGERY CENTER, LLC

Practice address

1710 Mayfield Dr
Jonesboro, AR 72401

Phone

(501) 554-1273

NPI assigned

Sep 10, 2019

Last updated

Jan 27, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelli Young, RN

Title

Administrator

Phone

(501) 554-1273

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Listed as

Jonesboro Ambulatory Surgery CenterCCN 04C0001102

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Practitioners 4

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.

• Nathan John McLaughlin, MD

  • Internal Medicine Physician
  • Batesville, AR
  • NPI 1881886638
  NPD (past)
• Ted Shields, D.O.

  • Interventional Pain Medicine Physician
  • Jonesboro, AR
  • NPI 1972666147
  NPD (past)
• Meraj Siddiqui, MD

  • Interventional Pain Medicine Physician
  • Batesville, AR
  • NPI 1114973922
  NPD (past)
• Dennis Dewayne McCoy, M.D

  • Interventional Pain Medicine Physician
  • Cordova, TN
  • NPI 1700818804
  NPD (past)

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1285283432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N SHACKLEFORD RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 MAYFIELD DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "501-554-1273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONESBORO AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-10",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "501-554-1273",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie L Jones
• Tahara Jones
• Taya Monik Jones
• Tiffany Carol Jones, M.C.D. CF-SLP
• Tracy Jones, PT
• Jonesboro Anesthesia Inc
• Jonesboro Anesthesia Services LLC
• Jonesboro Care and Rehabilitation Center, LLC (St. Elizabeth's Place)
• Jonesboro Church Health Center
• Jonesboro Ep, LLC

• Ambulatory Surgical Clinic/Center in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Ambulatory Surgical Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.