Eye Surgery Center of Maryville LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

7002132 Issued in IL

Legal business name

EYE SURGERY CENTER OF MARYVILLE LLC

Doing business as

Eyes of Illinois Surgery Center

Practice address

12 Professional Park Dr
Maryville, IL 62062-5672

Phone

(618) 288-7483

Fax

(618) 288-4583

NPI assigned

Jul 7, 2005

Last updated

Apr 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joseph Pravoot Gira, MDNPI 1861481152

Title

VP, Cmo

Phone

(314) 909-0633

Specialties & licenses 1

Addresses

Other names 1

• Eyes of Illinois Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Novamed Eye Surgery Center of Maryville LLC Dba Eyes of Illinois Surgery CenterCCN 14C0001057

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

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

• Novamed Management Services LLC

  dba Atlanta Eye Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Atlanta, GA
  • NPI 1992708929

  Member Of

  NPD member

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph Pravoot Gira, MD

  • Ophthalmology Physician
  • Des Peres, MO
  • NPI 1861481152
  Authorized official Same address or phone
• Kathryn K Sarabia, CRNA

  • Certified Registered Nurse Anesthetist
  • Granite City, IL
  • NPI 1457486920
  NPD (past)
• Douglas L. McDonald, CRNA

  • Certified Registered Nurse Anesthetist
  • Indianapolis, IN
  • NPI 1467462671
  NPD (past)
• Lisa R. Rybak, CRNA

  • Certified Registered Nurse Anesthetist
  • Saint Louis, MO
  • NPI 1114906955
  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1386641066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 PROFESSIONAL PARK DR",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625672",
            "telephone_number": "618-288-7483",
            "fax_number": "618-288-7196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 PROFESSIONAL PARK DR",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625672",
            "telephone_number": "618-288-7483",
            "fax_number": "618-288-4583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SURGERY CENTER OF MARYVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "GIRA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "PRAVOOT",
        "authorized_official_title_or_position": "VP, CMO",
        "authorized_official_telephone_number": "314-909-0633",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7002132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyes of Illinois Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Ellis, LCSW
• Elmwood Nursing & Rehabilitation Center, L.L.C.
• Andrew English, DDS
• Sheena D Eslinger, FNP-BC
• Amanda M Eversgerd
• Eyecare Management LLC (Illinois Eye Surgeons)
• Abby Fabela
• Fairview Heights Medical Group SC (The Heart Care Group)
• Christopher Farrar, M.D.
• Thomas Fay

• Ambulatory Surgical Clinic/Center in Maryville, IL
• Providers in Maryville, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.