Active NPI
Pumpkin Patch Ambulatory Surgical Center, LLC
Doing business as Orlando Avenue Surgery Center, LLC
- Ambulatory Surgical Clinic/Center
- Winter Park, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- Legal business name
- PUMPKIN PATCH AMBULATORY SURGICAL CENTER, LLC
- Doing business as
- Orlando Avenue Surgery Center, LLC
- Practice address
- 1500 S Orlando Ave
Winter Park, FL 32789-5500 - Phone
- (407) 740-0909
- Fax
- (407) 756-1605
- NPI assigned
- Jul 19, 2017
- Last updated
- Apr 17, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Randall A Loy, MD
- Title
- Physician/Owner
- Phone
- (407) 740-0909
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Primary |
Addresses
Primary practice location
1500 S Orlando Ave
Winter Park, FL 32789-5500
Mailing address
1500 S Orlando Ave Ste 100
Winter Park, FL 32789-5500
Phone (407) 740-0909
Other names 1
- Orlando Avenue Surgery Center, LLC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180117000453 | FL | Part B Supplier - Ambulatory Surgical Center | 5799044939 | Practice locations: Winter Park, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1295258416. Details of each certification follow.
Ambulatory surgical center certification: CCN 10C0001624
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- ORLANDO AVENUE SURGERY CENTER
- Certification status
- Active
- Provider type (POS)
- Ambulatory surgical center
- Participating since
- Jun 14, 2018
- Last certification
- Jun 14, 2018
- Ownership / control type
- Proprietary
- Facility address
- 1500 S Orlando Ave
Winter Park, FL 32789
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2134561 | Orlando Avenue Surgery Center | Certificate of waiver | Aug 3, 2027 |
National Provider Directory
National Provider DirectoryLocations
1500 S Orlando Ave
Ste 100
Winter Park, FL 32789
Phone (407) 917-2601
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Practitioners & affiliated clinicians
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.
-
- Reproductive Endocrinology Physician
- Winter Park, FL
- NPI 1548269004
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500422400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1713312000000",
"number": "1295258416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 S ORLANDO AVE STE 100",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327895500",
"telephone_number": "407-740-0909",
"fax_number": "407-821-3489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 S ORLANDO AVE",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327895500",
"telephone_number": "407-740-0909",
"fax_number": "407-756-1605"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PUMPKIN PATCH AMBULATORY SURGICAL CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-07-19",
"last_updated": "2024-04-17",
"certification_date": "2024-04-17",
"status": "A",
"authorized_official_last_name": "LOY",
"authorized_official_first_name": "RANDALL",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "PHYSICIAN/OWNER",
"authorized_official_telephone_number": "407-740-0909",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Orlando Avenue Surgery Center, LLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; 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.
- 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.