Organization Active NPI

Urologic Surgical Care PLLC

  • Urology Physician
  • Lawrence, NY
National Provider Identifier
1366612434
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
235437 Issued in NY
Legal business name
UROLOGIC SURGICAL CARE PLLC
Practice address
290 Central Avenue
#207
Lawrence, NY 11559-8507
Phone
(516) 239-8585
NPI assigned
Mar 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

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

Authorized official

Name
Dr. Jason A Grotas, MDNPI 1922092295
Title
Owner
Phone
(516) 239-8585

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
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X 235437 NY Primary

Addresses

Primary practice location

290 Central Avenue
#207
Lawrence, NY 11559-8507

Mailing address

290 Central Avenue
#207
Lawrence, NY 11559-8507
Phone (516) 239-8585

Other identifiers 1

IdentifierTypeStateIssuer
02663321MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050909000811 NY Part B Supplier - Clinic/Group Practice 0042242075 Receives reassigned benefits from 1 practitioner
Practice locations: New Hyde Park, NY; Lawrence, NY; Far Rockaway, Ny, NY

National Provider Directory

National Provider Directory

Locations

290 Central Ave
Ste 207
Lawrence, NY 11559
Phone (516) 239-8585

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1366612434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 CENTRAL AVENUE",
            "address_2": "#207",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115598507",
            "telephone_number": "516-239-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 CENTRAL AVENUE",
            "address_2": "#207",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115598507",
            "telephone_number": "516-239-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGIC SURGICAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-05",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "GROTAS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-239-8585",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "NY",
            "license": "235437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02663321",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.