Bloomington ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

14-011996-1 Issued in IN

Legal business name

BLOOMINGTON ASC, LLC

Practice address

1380 W Arch Haven Ave
Bloomington, IN 47403-2055

Phone

(812) 330-1164

Fax

(812) 332-5102

NPI assigned

Jan 24, 2014

Organization subpart

No

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

Authorized official

Name

Peter Blach

Title

Officer/Authorized Official

Phone

(713) 343-0832

Specialties & licenses 1

Addresses

Other names 1

• Indiana Specialty Surgery Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

Bloomington ASC LLC Dba Indiana Specialty Surgery CenterCCN 15C0001169

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.

• VHS San Antonio Partners LLC

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1356764484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 W ARCH HAVEN AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032055",
            "telephone_number": "812-330-1164",
            "fax_number": "812-332-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 W ARCH HAVEN AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032055",
            "telephone_number": "812-330-1164",
            "fax_number": "812-332-5102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-24",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "BLACH",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "713-343-0832"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "14-011996-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Indiana Specialty Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.