Fullerton Surgery Center LTD

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

042618689 Issued in IL

Legal business name

FULLERTON SURGERY CENTER LTD

Practice address

4849 W Fullerton Ave
Chicago, IL 60639-2503

Phone

(773) 237-2900

Fax

(773) 622-0769

NPI assigned

Jun 9, 2006

Last updated

Feb 6, 2018By 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

Naser Rustom, M.D.

Title

Owner/Medical Director

Phone

(773) 237-2900

Specialties & licenses 1

Addresses

Other names 1

• FULLERTON SURGERY CENTER INC Other name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Fullerton Surgery CenterCCN 14C0001174

Medicare certification status

ActiveFrom the Provider of Services file

Listed as

Fullerton Surgery Center IncCCN 14C0001123

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

CLIA laboratory certificates

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517875200000",
    "number": "1285675678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4849 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606392503",
            "telephone_number": "773-237-2900",
            "fax_number": "773-622-0769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4849 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606392503",
            "telephone_number": "773-237-2900",
            "fax_number": "773-622-0769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON SURGERY CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2018-02-06",
        "status": "A",
        "authorized_official_last_name": "RUSTOM",
        "authorized_official_first_name": "NASER",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "773-237-2900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "042618689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FULLERTON SURGERY CENTER INC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; 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.