St. Lucy's Outpatient Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ST. LUCY'S OUTPATIENT SURGERY CENTER, LLC

Practice address

21275 Olean Blvd
Port Charlotte, FL 33952-6704

Phone

(941) 625-1325

Fax

(941) 625-0131

NPI assigned

Jul 14, 2005

Last updated

May 19, 2026By 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

Kevin Becker

Title

Cfo

Phone

(470) 243-2259

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St. Lucy's Outpatient Surgery Center, Inc Former legal business name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

St Lucys Outpatient Surgery Center IncCCN 10C0001085

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

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Practitioners 3

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.

• Sara Bijan, MD

  • Ophthalmology Physician
  • Port Charlotte, FL
  • NPI 1407351083
  Medicare reassignment NPD
• Giovanni Taibbi, MD

  • Ophthalmology Physician
  • Port Charlotte, FL
  • NPI 1043740046
  Medicare reassignment NPD
• Emmanuel Harold Kai-Lewis, M.D.

  • Ophthalmology Physician
  • Tempe, AZ
  • NPI 1376749184

  FL

  Medicare reassignment NPD

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1326047101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352468575",
            "telephone_number": "864-359-1308",
            "fax_number": "239-496-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21275 OLEAN BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526704",
            "telephone_number": "941-625-1325",
            "fax_number": "941-625-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUCY'S OUTPATIENT SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "470-243-2259"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "79068100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Lucy's Outpatient Surgery Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Spliddie Harrison
• Split Mountain Emergency Physicians LLC
• Split Mountain Emergency Physicians LLC
• St Vincent Depaul Volunteer Community Pharmacy (Virginia Andes Volunteer Community Pharmacy)
• St. Joseph Emergency Medical Physicians PA (Florida Regional Emergency Associates)
• Maura Stanchak, D.D.S.
• Sarah Stanton, ARNP
• Dennis J Stapleton, M.D.
• Marissa Starr, AGACNP
• Robert A Statfeld, MD

• Ambulatory Surgical Clinic/Center in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2026; 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.