NPIMap

Organization Active NPI

Head and Neck Surgery Associates, PSC

  • Ambulatory Surgical Clinic/Center
  • Florence, KY
National Provider Identifier
1396823381
Registry record updated Apr 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
300097 Issued in KY
Legal business name
HEAD AND NECK SURGERY ASSOCIATES, PSC
Practice address
7575 US 42
Florence, KY 41042-1939
Phone
(859) 781-4900
Fax
(859) 572-3035
NPI assigned
Nov 1, 2006
Last updated
Apr 27, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
HEAD AND NECK SURGERY ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2018

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

Authorized official

Name
Jessica Detrick
Title
Coo
Phone
(859) 572-4104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 300097 KY Primary

Addresses

Primary practice location

7575 US 42
Florence, KY 41042-1939

Mailing address

40 N Grand Ave Ste 103
Fort Thomas, KY 41075-1771
Phone (859) 781-4900

Other identifiers 5

IdentifierTypeStateIssuer
490002867OtherMEDICARE RR
300097OtherKYKY LICENSE
36000735MedicaidKY
000000198567OtherANTHEM
6800084OtherUNITED HEALTHCARE

Other names 1

  • Center for Surgical Care Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091230000224 KY Part B Supplier - Ambulatory Surgical Center 4183662158 Practice locations: Florence, KY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Head and Neck Surgery Associates PSC Dba Center for Surgical CareCCN 18C0001024
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0983247Center for Surgical Care7575 US Highway 42, Florence, KY 41042Certificate of waiverFeb 20, 2027

National Provider Directory

National Provider Directory
Part of
Head Neck Surgery Ass

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524787200000",
    "number": "1396823381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 N GRAND AVE STE 103",
            "city": "FORT THOMAS",
            "state": "KY",
            "postal_code": "410751771",
            "telephone_number": "859-781-4900",
            "fax_number": "859-572-3039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7575 US 42",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410421939",
            "telephone_number": "859-781-4900",
            "fax_number": "859-572-3035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAD AND NECK SURGERY ASSOCIATES, PSC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEAD AND NECK SURGERY ASSOCIATES",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-04-27",
        "status": "A",
        "authorized_official_last_name": "DETRICK",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "859-572-4104"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "KY",
            "license": "300097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "490002867",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY LICENSE",
            "identifier": "300097",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36000735",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000198567",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "6800084",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Surgical Care",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Center for Surgical Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Florence, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2018; 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.