Sunnyside Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

P140-7 Issued in ID

Legal business name

SUNNYSIDE SURGERY CENTER, LLC

Practice address

3345 S Holmes Ave Ste B
Idaho Falls, ID 83404-7981

Phone

(208) 528-2858

Fax

(208) 528-8022

NPI assigned

Aug 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael K James, DPMNPI 1629111497

Title

Owner

Phone

(208) 528-2858

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Listed as

Sunnyside Surgery Center LLCCCN 13C0001055

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

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael K. James, DPM

  • Podiatrist
  • Idaho Falls, ID
  • NPI 1629111497
  NPD Authorized official

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186358400000",
    "number": "1285825075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3345 S HOLMES AVE STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047981",
            "telephone_number": "208-528-2858",
            "fax_number": "208-528-8022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 S HOLMES AVE STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047981",
            "telephone_number": "208-528-2858",
            "fax_number": "208-528-8022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNNYSIDE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-06",
        "last_updated": "2007-08-06",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-528-2858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "ID",
            "license": "P140-7",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00010151664",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "04804",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Summit Orthopaedics Management and Consulting, LLC
• Summit Orthopaedics Management and Consulting, LLC
• Summus Counseling, LLC
• Sunnyside Dental Care LLC
• Sunnyside Dental Care PC
• Sunrise Ketamine Clinic LLC
• Deena Surerus, LPN
• Surgery Center Anesthesia PLLC
• Brent Michael Sutherland, CRNA
• Staci Sutherland, LMSW

• Ambulatory Surgical Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; 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.