Eye Care Surgery Center of Memphis, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0000000167 Issued in TN

Legal business name

EYE CARE SURGERY CENTER OF MEMPHIS, LLC

Practice address

5350 Poplar Ave
Suite 900
Memphis, TN 38119-3699

Phone

(901) 473-8115

Fax

(901) 473-8116

NPI assigned

Oct 23, 2006

Last updated

Jul 25, 2022By 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

Dr. Subba R. Gollamudi, M.D.NPI 1154378735

Title

Chairman and Manager

Phone

(901) 685-2200

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396828323. Details of each certification follow.

• CCN 44C0001141 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 44C0001141

Legal name

Eye Care Surgery Center Of Memphis, Llc

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jun 21, 2004

Last certification

Jun 12, 2017

Ownership / control type

Proprietary

Facility address

5350 Poplar Avenue Suite 900
Memphis, TN 38119

Locations

Practitioners 1

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.

• Subba R Gollamudi, M.D.

  • Ophthalmology Physician
  • Memphis, TN
  • NPI 1154378735
  NPD Authorized official

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1396828323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 RIDGE LAKE BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209411",
            "telephone_number": "901-685-2200",
            "fax_number": "901-255-5631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5350 POPLAR AVE",
            "address_2": "SUITE 900",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381193699",
            "telephone_number": "901-473-8115",
            "fax_number": "901-473-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE SURGERY CENTER OF MEMPHIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "GOLLAMUDI",
        "authorized_official_first_name": "SUBBA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CHAIRMAN AND MANAGER",
        "authorized_official_telephone_number": "901-685-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "0000000167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03670046",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3288892",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Memphis, TN
• Providers in Memphis, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.