Emerald Coast Surgery Center, LP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

996 Issued in FL

Legal business name

EMERALD COAST SURGERY CENTER, LP

Doing business as

Emerald Coast Surgery Center

Practice address

995 Mar Walt Drive
Fort Walton Beach, FL 32547

Phone

(850) 863-7887

Fax

(850) 863-6645

NPI assigned

Apr 20, 2006

Last updated

Jan 27, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Anne Kachelhoffer

Title

Administrator

Phone

(850) 863-8165

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Emerald Coast Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Emerald Coast Surgery Center LPCCN 10C0001189

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 2

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

• St Vincents Health System Inc

  dba Ascension St Vincent's St. Johns County

  • General Acute Care Hospital
  • Saint Johns, FL
  • NPI 1861078651

  Member Of

  NPD member
• White-Wilson Medical Center PA

  dba White-Wilson Medical Center

  • Clinic/Center
  • Fort Walton Beach, FL
  • NPI 1467437277

  Member Of

  NPD member

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422316800000",
    "number": "1437114378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 MAR WALT DRIVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "32547",
            "telephone_number": "850-863-7887",
            "fax_number": "850-863-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "995 MAR WALT DRIVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "32547",
            "telephone_number": "850-863-7887",
            "fax_number": "850-863-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST SURGERY CENTER, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2015-01-27",
        "status": "A",
        "authorized_official_last_name": "KACHELHOFFER",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-863-8165",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0791423",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emerald Coast Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emerald Coast Psychotherapy, LLC
• Emerald Coast Rehabilitation Center, LLC (Emerald Coast Center)
• Emerald Coast Speech Therapy LLC
• Emerald Coast Sports Medicine and Orthopaedics, P.a.
• Emerald Coast Support Coordinators, Inc.
• Emerald Coast Surgical Associates, LLC
• Emerald Coast TMS of Fort Walton Beach
• Emerald Coast Urology
• Emergency Providers Group LLC
• Empower Today Therapy LLC

• Ambulatory Surgical Clinic/Center in Fort Walton Beach, FL
• Providers in Fort Walton Beach, 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 Jan 27, 2015; 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.