Shore Outpatient Surgicenter LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

22372 Issued in NJ

Legal business name

SHORE OUTPATIENT SURGICENTER LLC

Practice address

360 Route 70
Lakewood, NJ 08701-5823

Phone

(732) 942-9835

Fax

(732) 886-1573

NPI assigned

Jul 1, 2005

Organization subpart

No

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

Authorized official

Name

Jonathan Bailey

Title

Authorized Official

Phone

(203) 609-1168

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Listed as

Shore Outpatient Surgicenter LLCCCN 31C0001099

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

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

• Baylor University Medical Center

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1447250253

  Member Of

  NPD member
• VHS San Antonio Partners LLC

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

  Member Of

  NPD member

Interoperability endpoints

• FHIR API: https://0827cc7d-e0ad-4083-9f40-e122b2b8bb2c.gastro.prod.fhir.ema-api.com/fhir/r4/

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1366449571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 ROUTE 70",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015823",
            "telephone_number": "732-942-9835",
            "fax_number": "732-886-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 ROUTE 70",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015823",
            "telephone_number": "732-942-9835",
            "fax_number": "732-886-1573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE OUTPATIENT SURGICENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "203-609-1168"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NJ",
            "license": "22372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7642504",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490003641",
            "state": "NJ"
        }
    ],
    "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",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shore Institute for Reproductive Medicine,PC
• Shore Medicine LLC
• Shore Oral Maxillo Surgery Group PA
• Shore Orthopaedic Group
• Shore Orthopaedic Group
• Shore Point Medical Associates LLC
• Shore Point OB & GYN, LLC
• Shore Spine and Pain
• Shore Surgical Pavilion, LLC
• Shoshana Rose Physical Therapy

• Ambulatory Surgical Clinic/Center in Lakewood, NJ
• Providers in Lakewood, NJ by specialty
• Ambulatory Surgical Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.