Prime Healthcare ASC - Northridge LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PRIME HEALTHCARE ASC - NORTHRIDGE LLC

Doing business as

Prime Healthcare Surgical Center of the Valley

Practice address

19331 Business Center Dr Ste 102
Northridge, CA 91324-3533

Phone

(818) 709-5555

NPI assigned

Jul 30, 2021

Organization subpart

No

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

Authorized official

Name

Christopher Doan

Title

Managing Associate General Counsel

Phone

(310) 259-4706

Specialties & licenses 1

Addresses

Other names 1

• Prime Healthcare Surgical Center of the Valley Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Ambulatory surgical center certification: CCN 55C0001133

Legal name

PRIME HEALTHCARE SURGICAL CENTER OF THE VALLEY

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Mar 24, 2023

Last certification

Jun 6, 2023

Ownership / control type

Proprietary

Facility address

19331 Business Center Dr Suite 102
Northridge, CA 91324

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1407529845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3480 E GUASTI RD FL 2",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917617684",
            "telephone_number": "310-259-4706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19331 BUSINESS CENTER DR STE 102",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913243533",
            "telephone_number": "818-709-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE ASC - NORTHRIDGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-30",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING ASSOCIATE GENERAL COUNSEL",
        "authorized_official_telephone_number": "310-259-4706"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prime Healthcare Surgical Center of the Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lesley C Prince, MD
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• Stefanie A Proia, CPNP
• Crystal Prosper

• Ambulatory Surgical Clinic/Center in Northridge, CA
• Providers in Northridge, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; 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.
• 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.