Executive Surgery Center of Little Rock, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EXECUTIVE SURGERY CENTER OF LITTLE ROCK, LLC

Practice address

11220 Executive Center Dr
Suite 100
Little Rock, AR 72211-4320

Phone

(501) 312-2121

Fax

(501) 312-2330

NPI assigned

Apr 6, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Britney Deshae Smith, RN

Title

Administrator

Phone

(501) 312-2121

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Hospital certification: CCN 040160

Legal name

EXECUTIVE SURGERY CENTER OF LITTLE ROCK LLC

Certification status

Terminated Voluntary: merger or closure, Dec 1, 2021

Provider type (POS)

Hospital – Short-term

Participating since

Aug 17, 2020

Last certification

Aug 17, 2020

Beds

1

Ownership / control type

Private (not for profit)

Facility address

11220 Executive Center Drive, Suite 100
Little Rock, AR 72211

Listed as

Executive Surgery Center of Little Rock LLCCCN 04C0001092

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

Locations

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1386177376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11220 EXECUTIVE CENTER DR",
            "address_2": "SUITE 100",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114320",
            "telephone_number": "501-312-2121",
            "fax_number": "501-312-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11220 EXECUTIVE CENTER DR",
            "address_2": "SUITE 100",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114320",
            "telephone_number": "501-312-2121",
            "fax_number": "501-312-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE SURGERY CENTER OF LITTLE ROCK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-06",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRITNEY",
        "authorized_official_middle_name": "DESHAE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "501-312-2121",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "6098850",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "3130254",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225821128",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA COVENTRY",
            "identifier": "970544",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Ambulatory Surgical Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.