NPIMap

Organization Active NPI

St Michaels Surgery Center Inc.

  • Ambulatory Surgical Clinic/Center
  • Largo, FL
National Provider Identifier
1336100189
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
1118 Issued in FL
Legal business name
ST MICHAELS SURGERY CENTER INC.
Practice address
1018 W Bay Dr
Largo, FL 33770-3225
Phone
(727) 585-2200
Fax
(727) 584-9239
NPI assigned
Mar 31, 2006
Last updated
Nov 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John L Michaelos, M.D.NPI 1851353239
Title
Owner
Phone
(727) 585-2200

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)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 1118 FL Primary

Addresses

Primary practice location

1018 W Bay Dr
Largo, FL 33770-3225

Mailing address

1030 W Bay Dr Ste 200
Largo, FL 33770-3276
Phone (727) 585-2200

Other identifiers 3

IdentifierTypeStateIssuer
50101269OtherFLAETNA PROVIDER ID
070826700MedicaidFL
69KOtherFLBCBS PROVIDER ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130604000479 FL Part B Supplier - Ambulatory Surgical Center 1557509478 Receives reassigned benefits from 6 practitioners
Practice locations: Largo, FL

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
St Michaels Surgery CenterCCN 10C0001347
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0985940St Michaels Surgery Center1018 West Bay Drive Suite B, Largo, FL 33770Certificate of waiverMay 1, 2027

National Provider Directory

National Provider Directory

Locations

1018 West Bay Dr
Largo, FL 33770
Phone (727) 585-2200

1018 West Bay Dr
Ste B
Largo, FL 33770
Phone (727) 585-2200

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1336100189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 W BAY DR STE 200",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703276",
            "telephone_number": "727-585-2200",
            "fax_number": "813-697-1758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 W BAY DR",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703225",
            "telephone_number": "727-585-2200",
            "fax_number": "727-584-9239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MICHAELS SURGERY CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A",
        "authorized_official_last_name": "MICHAELOS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-585-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER ID",
            "identifier": "50101269",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070826700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "69K",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; 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.