Space Coast Surgical Center LTD

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

984 Issued in FL

Legal business name

SPACE COAST SURGICAL CENTER LTD

Practice address

220 N Sykes Creek Pkwy
Suite 101
Merritt Island, FL 32953-3490

Phone

(321) 459-0015

Fax

(321) 459-2291

NPI assigned

Apr 10, 2006

Organization subpart

No

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

Authorized official

Name

Cynthia A Johnson

Title

Administrator

Phone

(321) 459-0015

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Merritt Island Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Merrit Island Surgery CenterCCN 10C0001132

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

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners 1

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

• Brian Rye

  • Athletic Trainer
  • Merritt Island, FL
  • NPI 1174633895
  NPD

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459123200000",
    "number": "1437112455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N SYKES CREEK PKWY",
            "address_2": "SUITE 101",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329533490",
            "telephone_number": "321-459-0015",
            "fax_number": "321-459-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N SYKES CREEK PKWY",
            "address_2": "SUITE 101",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329533490",
            "telephone_number": "321-459-0015",
            "fax_number": "321-459-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST SURGICAL CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2016-03-28",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-459-0015"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079154700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Merritt Island Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Space Coast Dermatology Clinic, PLLC
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• Space Coast Orthopaedic Center PL
• Space Coast Rheumatology & Arthritis Center PA
• Space Coast Surgery Center LLC
• Alan Gerard Spears
• SPMJ, Inc.
• Sports Medicine and Rehab Fitness
• SS & PM Inc
• SSBP Management LLC

• Ambulatory Surgical Clinic/Center in Merritt Island, FL
• Providers in Merritt Island, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; 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.