Stonecreek Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

STONECREEK SURGERY CENTER LLC

Practice address

5915 S Rainbow Blvd Ste 108
Las Vegas, NV 89118-2558

Phone

(702) 227-7959

Fax

(702) 227-6344

NPI assigned

May 20, 2008

Organization subpart

No

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

Authorized official

Name

Amy Grim

Title

Credentialing Specialist

Phone

(702) 202-4776

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Listed as

Stonecreek Surgery CenterCCN 29C0001072

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1417114166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 W HORIZON RIDGE PKWY STE 300",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524395",
            "telephone_number": "702-202-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 S RAINBOW BLVD STE 108",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891182558",
            "telephone_number": "702-227-7959",
            "fax_number": "702-227-6344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONECREEK SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "GRIM",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "702-202-4776"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417114166",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Stone
• Shakeria Stone
• Susan Marie Stone, L.M.T.
• Tanya Marie Stone, PHARMD
• Stonebridge Behavioral Health LLC
• Amber Stoner
• Alan Charles Stonesifer, CABI
• Angela Stonum
• Stonybrook Foundation
• Micah Joye Stoor

• Ambulatory Surgical Clinic/Center in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Ambulatory Surgical Clinic/Center in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; 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.