Physicians Surgery Center at Good Samaritan, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

7003172 Issued in IL

Legal business name

PHYSICIANS SURGERY CENTER AT GOOD SAMARITAN, LLC

Doing business as

Good Samaritan Surgery Center

Practice address

2 Good Samaritan Way
Ste 200
Mount Vernon, IL 62864-2476

Phone

(618) 899-5703

Fax

(618) 899-5704

NPI assigned

Jul 30, 2012

Last updated

Jan 8, 2025By 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

Joon Ahn, MD

Title

Authorized Official - Owner

Phone

(618) 899-5703

Specialties & licenses 1

Addresses

Other names 1

• Good Samaritan Surgery Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Physicians Surgery Center at Good Samaritan LLCCCN 14C0001157

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

Member of 1

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

• VHS San Antonio Partners, LLC

  dba Westover Hills Baptist Hospital

  • General Acute Care Hospital
  • San Antonio, TX
  • NPI 1831970532

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1285980151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY",
            "address_2": "STE 200",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642476",
            "telephone_number": "618-899-5703",
            "fax_number": "618-899-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY",
            "address_2": "STE 200",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642476",
            "telephone_number": "618-899-5703",
            "fax_number": "618-899-5704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS SURGERY CENTER AT GOOD SAMARITAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-30",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "AHN",
        "authorized_official_first_name": "JOON",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL - OWNER",
        "authorized_official_telephone_number": "618-899-5703",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7003172",
            "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": "Good Samaritan Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Samaritan Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Physician Services Corp of Southern Illinois (St marys Good Samaritan medical group)
• Physician Services Corporation of Southern Illinois (St Marys Good Samaritan Medical Group)
• Physician Services Corporation of Southern Illinois Inc (St. Mary's Good Samaritan Medical Group)
• Physician Services Corporation of Southern Illinois Inc. (SSM Health Medical Group)
• Physician Services Corporation of Southern Illinois S.C (St. Marys Good Samaritan Medical Group Ultrasound)
• Matt Christopher Pina
• Lauren Marie Pingsterhaus, PA-C
• Kerry Lynn Pitchford, APRN, FNP-BC
• Megan Nicole Plummer, APRN
• Nicholas Pollmann

• Ambulatory Surgical Clinic/Center in Mount Vernon, IL
• Providers in Mount Vernon, 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 Jan 8, 2025; 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.