NPIMap

Organization Active NPI

Dental Surgery Centers of America

Doing business as Grace Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Santa Maria, CA
National Provider Identifier
1407130727
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
DENTAL SURGERY CENTERS OF AMERICA
Doing business as
Grace Surgery Center
Practice address
1418 E Main St
Suite 110
Santa Maria, CA 93454-4833
Phone
(209) 952-9000
Fax
(209) 373-1190
NPI assigned
Oct 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Mr. Devin Larsen
Title
Ceo
Phone
(208) 340-1840

Specialties & licenses 1

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

Addresses

Primary practice location

1418 E Main St
Suite 110
Santa Maria, CA 93454-4833

Mailing address

1523 E March LN Ste a
Stockton, CA 95210-5607
Phone (209) 952-9000

Other names 1

  • Grace Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190923003346 CA Part B Supplier - Ambulatory Surgical Center 0244394302 Practice locations: Santa Maria, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407130727. Details of each certification follow.

Ambulatory surgical center certification: CCN 05C0001010

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GRACE SURGERY CENTER
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Apr 6, 1983
Last certification
Jun 18, 2015
Ownership / control type
Non-Profit
Facility address
1418 E Main St Ste 110
Santa Maria, CA 93454

Other NPIs with the same Medicare PAC ID 2

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

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
05D2181085Grace Surgery Center1418 East Main Street Suite 110, Santa Maria, CA 93454Certificate of waiverMar 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Castle Surgicenter Partnership4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1317772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1407130727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 E MARCH LN STE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952105607",
            "telephone_number": "209-952-9000",
            "fax_number": "209-373-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 E MAIN ST",
            "address_2": "SUITE 110",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544833",
            "telephone_number": "209-952-9000",
            "fax_number": "209-373-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SURGERY CENTERS OF AMERICA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-05",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-340-1840",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grace Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grace Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.