NPIMap

Organization Active NPI

Riverside Ambulatory Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Salisbury, MD
National Provider Identifier
1356311419
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
A1077 Issued in MD
Legal business name
RIVERSIDE AMBULATORY SURGERY CENTER LLC
Practice address
560 Riverside Drive
#A-101
Salisbury, MD 21801-4700
Phone
(410) 749-0121
Fax
(410) 749-6807
NPI assigned
Jan 23, 2006
Last updated
Mar 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Authorized official

Name
Dr. Kevin Thomas, D.P.M.NPI 1316141294
Title
Medical Director
Phone
(410) 749-0121

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 A1077 MD Primary

Addresses

Primary practice location

560 Riverside Drive
#A-101
Salisbury, MD 21801-4700

Mailing address

560 Riverside Drive
#A-101
Salisbury, MD 21801-4700
Phone (410) 749-0121

Other identifiers 4

IdentifierTypeStateIssuer
023TOtherMDCAREFIRST
320088OtherMDUNITED HEALTHCARE
T78068100MedicaidMD
NN1OtherDCBLUE SHEILD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080828000489 MD Part B Supplier - Ambulatory Surgical Center 8820164726 Practice locations: Salisbury, MD

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Riverside Ambulatory Surgery Center LLCCCN 21C0001077
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 2

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1356311419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 RIVERSIDE DRIVE",
            "address_2": "#A-101",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218014700",
            "telephone_number": "410-749-0121",
            "fax_number": "410-749-6807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 RIVERSIDE DRIVE",
            "address_2": "#A-101",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218014700",
            "telephone_number": "410-749-0121",
            "fax_number": "410-749-6807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE AMBULATORY SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-23",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "410-749-0121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "023T",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "320088",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T78068100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHEILD",
            "identifier": "NN1",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; 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.