Executive Ambulatory Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EXECUTIVE AMBULATORY SURGICAL CENTER, LLC

Practice address

17000 Executive Plaza Dr
Suite 301
Dearborn, MI 48126-2793

Phone

(313) 408-6613

NPI assigned

May 27, 2014

Organization subpart

No

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

Authorized official

Name

Samer Suleiman

Title

Manager

Phone

(313) 789-5579

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Executive Ambulatory Surgical Center LLCCCN 23C0001133

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

Practitioners 1

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

• Ali E Beydoun, MD

  • Anesthesiology Physician
  • Garden City, MI
  • NPI 1508361205
  Medicare reassignment

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

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1386056356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 EXECUTIVE PLAZA DR STE 301",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262793",
            "telephone_number": "313-789-5579",
            "fax_number": "313-789-5589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17000 EXECUTIVE PLAZA DR",
            "address_2": "SUITE 301",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262793",
            "telephone_number": "313-408-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE AMBULATORY SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-27",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "SULEIMAN",
        "authorized_official_first_name": "SAMER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "313-789-5579"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

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