Sand Lake Surgicenter LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1289 Issued in FL

Legal business name

SAND LAKE SURGICENTER LLC

Practice address

7477 Sandlake Commons Blvd
Orlando, FL 32819-8034

Phone

(407) 264-9633

Fax

(407) 264-9959

NPI assigned

Feb 1, 2011

Organization subpart

No

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

Authorized official

Name

Ms. Cheryl Modica, L.H.R.M.

Title

Administrator

Phone

(407) 264-9633

Specialties & licenses 1

Addresses

Other names 1

• Sand Lake Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Sand Lake Surgicenter LLCCCN 10C0001507

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Jewett Orthopaedic Clinic LLC

  • Orthopaedic Surgery Physician
  • Winter Park, FL
  • NPI 1821097437

  Member Of

  NPD member

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 Maximo (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)

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

{
    "created_epoch": "1296518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317772800000",
    "number": "1336445873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7477 SANDLAKE COMMONS BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198034",
            "telephone_number": "407-264-9633",
            "fax_number": "407-264-9959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7477 SANDLAKE COMMONS BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198034",
            "telephone_number": "407-264-9633",
            "fax_number": "407-264-9959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAND LAKE SURGICENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-01",
        "last_updated": "2011-10-05",
        "status": "A",
        "authorized_official_last_name": "MODICA",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-264-9633",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "L.H.R.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sand Lake Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sand Lake Imaging LLLP
• Sand Lake Internal Medicine, LLC
• Sand Lake Medical Associates, P.a.
• Sand Lake Rehab & Wellness Center Inc
• Sand Lake Surgery Center, LP
• Leslie H Sand, PA-C
• Mark E Sand, M.D.
• Miriam R. Sanderlin, ARNP
• Scott Donald Sanderlin, RN
• Agnes Naomi Sanders, MSW

• Ambulatory Surgical Clinic/Center in Orlando, FL
• Providers in Orlando, 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 Oct 5, 2011; 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.