Mentor Surgery Center LTD

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0404AS Issued in OH

Legal business name

MENTOR SURGERY CENTER LTD

Practice address

9485 Mentor Ave
Ste 1
Mentor, OH 44060-4597

Phone

(440) 205-5454

Fax

(440) 205-5402

NPI assigned

Aug 9, 2005

Organization subpart

No

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

Authorized official

Name

Miss Tracy Ann Peters, CPC

Title

Business Office Manager

Phone

(440) 205-5467

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Listed as

Mentor Surgery Center LTDCCN 36C0001116

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

Member of 1

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

• Lake Hospital System, Inc.

  • Family Medicine Physician
  • Concord Township, OH
  • NPI 1316198724

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419984000000",
    "number": "1417958729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE",
            "address_2": "STE 1",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608711",
            "telephone_number": "440-205-5454",
            "fax_number": "440-205-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE",
            "address_2": "STE 1",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604597",
            "telephone_number": "440-205-5454",
            "fax_number": "440-205-5402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTOR SURGERY CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2014-12-31",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "440-205-5467",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": "0404AS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2106143",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mentor Operator, LLC
• Mentor Ops, LLC
• Mentor Pediatric Dentistry
• Mentor Smiles, Vladimir Khramoy, DDS, LLC
• Mentor SNF Healthcare LLC
• Mentor Way Nursing & Rehabilitation Center, Inc.
• Meridia Medical Group LLC
• Yih-Ting Huang Merk
• Doloris Merriman
• Kelly Merritt, MA

• Ambulatory Surgical Clinic/Center in Mentor, OH
• Providers in Mentor, OH by specialty
• Ambulatory Surgical Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2014; 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.