Advanced Surgical Associates

Key facts

NPI

1336323971

Entity type

Organization (NPI type 2)

Primary specialty

Specialist 174400000X

License

G52590 (CA)

Legal business name

ADVANCED SURGICAL ASSOCIATES

Practice address

3300 E South St
#201
Long Beach, CA 90805-4588

Phone

(562) 531-9272

Fax

(562) 408-0346

NPI assigned

Dec 18, 2007

Organization subpart

No

Authorized official

Name

Dr. Willie Goffney, MD NPI 1679776074

Title

President

Phone

(562) 930-3841

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Willie Henry Goffney Jr., MD Surgical Oncology Physician · Long Beach, CA · NPI 1679776074
  Medicare reassignment Authorized official CA
• Sam W. Abdelmelek, MD Internal Medicine Physician · Lakewood, CA · NPI 1649414855
  NPD
• Basem R. Farag, M.D Family Medicine Physician · Lakewood, CA · NPI 1457441974
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CA

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 29, 2015.

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443484800000",
    "number": "1336323971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 E SOUTH ST",
            "address_2": "#201",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "908054588",
            "telephone_number": "562-531-9272",
            "fax_number": "562-408-0346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 E SOUTH ST",
            "address_2": "#201",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908054588",
            "telephone_number": "562-531-9272",
            "fax_number": "562-408-0346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SURGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2015-09-29",
        "status": "A",
        "authorized_official_last_name": "GOFFNEY",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-930-3841",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G52590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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