Pegasus Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PEGASUS SURGERY CENTER LLC

Practice address

20162 SW Birch St Ste 100
Newport Beach, CA 92660-0797

Phone

(949) 508-1198

Fax

(949) 449-8564

NPI assigned

Nov 12, 2020

Last updated

Dec 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Tassos, CPA

Title

Cfo

Phone

(661) 965-5020

Specialties & licenses 1

Addresses

Other names 1

• Pegasus Surgery Center, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366044596. Details of each certification follow.

• CCN 55C0001119 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 55C0001119

Legal name

PEGASUS SURGERY CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Dec 9, 2022

Last certification

Nov 22, 2022

Ownership / control type

Proprietary

Facility address

20162 SW Birch St Suite 100
Newport Beach, CA 92660

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

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1366044596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13071 SOLINDA",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927828709",
            "telephone_number": "661-965-5020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20162 SW BIRCH ST STE 100",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926600797",
            "telephone_number": "949-508-1198",
            "fax_number": "949-449-8564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEGASUS SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-12",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "TASSOS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "661-965-5020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pegasus Surgery Center, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Pegasus Surgery Center, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Wallace W Peck, M.D.
• John A. Pecora, D.C.
• Peditric Subspecialy Faculty
• Felecia A Pedrogo, MA, AMFT, APCC
• Scott Peebles, M.A., MFCC
• Kristy Pegg, OT, CHT
• Michelle Pegler, OT
• Piotr Pelc, D.O.
• Paige Pelligra
• Edward Pellis, DDS

• Ambulatory Surgical Clinic/Center in Newport Beach, CA
• Providers in Newport Beach, 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 Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.