Eye Surgery Center of the Desert

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

CLN2276 Issued in CA

Legal business name

EYE SURGERY CENTER OF THE DESERT

Practice address

72301 Country Club Dr
Suite 101
Rancho Mirage, CA 92270-8007

Phone

(760) 776-8100

Fax

(760) 773-3823

NPI assigned

Aug 19, 2006

Organization subpart

No

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

Authorized official

Name

George Neal

Title

Assistant Secretary

Phone

(844) 377-6468

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Eye Surgery Center of the DesertCCN 55C0001016

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

Locations

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1336254770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72301 COUNTRY CLUB DR",
            "address_2": "SUITE 101",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922708007",
            "telephone_number": "760-776-8100",
            "fax_number": "760-773-3823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72301 COUNTRY CLUB DR",
            "address_2": "SUITE 101",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922708007",
            "telephone_number": "760-776-8100",
            "fax_number": "760-773-3823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SURGERY CENTER OF THE DESERT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "844-377-6468"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "CLN2276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Susan Ethridge, P.A.
• Bayani V. Evangelista, M.D.
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• Gregory E Evans, O.D.
• Executive Residential Care & Recovery LLC
• Aubrey Glenn Eyer, M.D.
• Faculty Medical Group of Llusm
• Faculty Physicians and Surgeons of Llusm
• Faculty Physicians and Surgeons of Llusm
• Blessing Fadaka, FNP

• Ambulatory Surgical Clinic/Center in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.