St. Louis Children's Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ST. LOUIS CHILDREN'S SURGERY CENTER, LLC

Practice address

12184 Natural Bridge Rd # 90
Bridgeton, MO 63044-2017

Phone

(314) 391-4936

Fax

(314) 474-0191

NPI assigned

Aug 10, 2023

Last updated

Jan 27, 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

Devin Larsen

Title

Ceo

Phone

(208) 340-1840

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316620933. Details of each certification follow.

• CCN 26C0001180 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 26C0001180

Legal name

Gateway Children's Surgery Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

May 3, 2024

Last certification

Apr 5, 2024

Facility address

12184 Natural Bridge Road, #90
Bridgeton, MO 63044

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.

• Tony W. McClure, D.D.S.

  • Pediatric Dentistry
  • Saint Louis, MO
  • NPI 1346284445
  NPD (past)

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

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1316620933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9709 LAKESIDE BLVD STE 350",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773811213",
            "telephone_number": "713-489-2198",
            "fax_number": "713-489-2978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12184 NATURAL BRIDGE RD # 90",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442017",
            "telephone_number": "314-391-4936",
            "fax_number": "314-474-0191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS CHILDREN'S SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-10",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-340-1840"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Matthew W Stadnyk, MD
• Sarah Staff, PT, DPT
• Emily Stageberg
• Remiko Cerrie Stallings

• Ambulatory Surgical Clinic/Center in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.