Organization Active NPI

Merritt Island Outpatient Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Merritt Island, FL
National Provider Identifier
1407335458
Registry record updated Sep 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
MERRITT ISLAND OUTPATIENT SURGERY CENTER, LLC
Practice address
450 E Merritt Island Cswy Ste 400
Merritt Island, FL 32952
Phone
(321) 735-6221
Fax
(813) 864-4436
NPI assigned
Aug 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2025

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

Authorized official

Name
Tracie GariNPI 1659315190
Title
Chief Administrative Officer
Phone
(813) 549-2134

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary
General Acute Care Hospital 282N00000X

Addresses

Primary practice location

450 E Merritt Island Cswy Ste 400
Merritt Island, FL 32952

Mailing address

PO Box 628771
Orlando, FL 32862-8771

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190109002422 FL Part B Supplier - Ambulatory Surgical Center 8820334063 Practice locations: Merritt Island, FL

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Merritt Island Outpatient Surgery CenterCCN 10C0001643
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
10D2161139Merritt Island Outpatient Surgery Center450 E Merritt Island, Merritt Island, FL 32952Certificate of waiverJan 27, 2027

National Provider Directory

National Provider Directory

Member of 1

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

Locations

450 E Merritt Island Cswy
Merritt Island, FL 32952

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758326400000",
    "number": "1407335458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 628771",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328628771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 E MERRITT ISLAND CSWY STE 400",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "32952",
            "telephone_number": "321-735-6221",
            "fax_number": "813-864-4436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERRITT ISLAND OUTPATIENT SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-10",
        "last_updated": "2025-09-20",
        "certification_date": "2025-09-20",
        "status": "A",
        "authorized_official_last_name": "GARI",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "813-549-2134"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2025; 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.