Shoreline Surgery Center, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

SHORELINE SURGERY CENTER, LLC

Practice address

4300 Long Beach Blvd Ste 150
Long Beach, CA 90807-2016

Phone

(562) 857-1928

NPI assigned

May 17, 2018

Organization subpart

No

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

Authorized official

Name

Lee Marek, DO

Title

Board Member

Phone

(831) 588-7296

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Ambulatory surgical center certification: CCN 05C0002270

Legal name

SHORELINE SURGERY CENTER LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Dec 17, 2020

Last certification

Dec 17, 2020

Ownership / control type

Proprietary

Facility address

4300 Long Beach Blvd, Suite 150
Long Beach, CA 90807

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.

• Vincent J. Valdez, M.D.

  • Pain Medicine Physician
  • Downey, CA
  • NPI 1588633762
  NPD (past)

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1386134062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 LONG BEACH BLVD STE 150",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908072016",
            "telephone_number": "562-857-1928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 LONG BEACH BLVD STE 150",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908072016",
            "telephone_number": "562-857-1928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "MAREK",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "831-588-7296",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gretchen Louise Sholty, PH.D.
• Nathaniel Nash Shon, MD
• Erin Cathleen Shook, CF-SLP
• Bradley Peter Shore, MFT
• Lauren Shore
• Shoreline Treatment Center, LLC
• Shoreline Treatment Center, LLC
• Shoreline Treatment Center, LLC
• Shoreline Treatment Center, LLC
• Lauryn Shorter

• Surgery Physician in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.
• 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.