Active NPI
Cape Coral Ambulatory Surgery Center, LLC
- Ambulatory Surgical Clinic/Center
- Cape Coral, FL
National Provider Identifier
1295772101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- License
- 1245
- Legal business name
- CAPE CORAL AMBULATORY SURGERY CENTER, LLC
- Doing business as
- Cape Coral Surgery Center
- Practice address
- 2721 Del Prado Blvd S
Suite 100
Cape Coral, FL 33904-5781 - Phone
- (239) 242-8010
- Fax
- (239) 242-8020
- NPI assigned
- May 31, 2006
- 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
- Jennifer Boyd Baldock
- Title
- Officer and Authorized Official
- Phone
- (615) 234-5954
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 1245 | FL | Primary |
Addresses
Primary practice location
2721 Del Prado Blvd S
Suite 100
Cape Coral, FL 33904-5781
Mailing address
2721 Del Prado Blvd S
Suite 100
Cape Coral, FL 33904-5781
Phone (239) 242-8010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6N1 | Other | FL | BLUE CROSS BLUE SHIELD FL |
Other names 1
- Cape Coral Surgery Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060209000579 | FL | Part B Supplier - Ambulatory Surgical Center | 4587679741 | Practice locations: Cape Coral, FL |
Hospital certification: CCN 100355
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
- CAPE CORAL AMBULATORY SURGERY CENTER, LLC
- Certification status
- Terminated Voluntary: merger or closure, Jan 1, 2023
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Sep 1, 2021
- Last certification
- Sep 1, 2021
- Beds
- 1
- Ownership / control type
- Private (for profit)
- Facility address
- 2721 Del Prado Blvd S, Ste 100
Cape Coral, FL 33904
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Cape Coral Surgery Center
- Medicare certification status
- Active
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 |
|---|---|---|---|
| 10D1040125 | Cape Coral Surgery Center | Certificate of waiver | May 1, 2027 |
National Provider Directory
National Provider DirectoryNetworks
- Optimum HealthCare HMO Network
- Freedom Health 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.
-
- Urology Physician
- Fort Myers, FL
- NPI 1639283534
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1677628800000",
"number": "1295772101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2721 DEL PRADO BLVD S",
"address_2": "SUITE 100",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339045781",
"telephone_number": "239-242-8010",
"fax_number": "239-242-8020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2721 DEL PRADO BLVD S",
"address_2": "SUITE 100",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339045781",
"telephone_number": "239-242-8010",
"fax_number": "239-242-8020"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CAPE CORAL AMBULATORY SURGERY CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-31",
"last_updated": "2023-03-01",
"certification_date": "2023-03-01",
"status": "A",
"authorized_official_last_name": "BALDOCK",
"authorized_official_first_name": "JENNIFER",
"authorized_official_middle_name": "BOYD",
"authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
"authorized_official_telephone_number": "615-234-5954"
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": "FL",
"license": "1245",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD FL",
"identifier": "6N1",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Cape Coral Surgery Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Cape Coral Surgery Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cape Coral, FL
- Hien Cao
- Cape American Facility LLC
- Cape Chateau Assisted Living LLC
- Cape Chateau Inc
- Cape Clarity Integrative Psychology, LLC
- Cape Coral Anesthesia Services, LLC
- Cape Coral Assisted Living Facility
- Cape Coral Assisted Living Facility East LLC
- Cape Coral Assisted Living Facility South LLC
- Cape Coral Counseling Professionals, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.