NPIMap

Organization Active NPI

Spine Sports Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Campbell, CA
National Provider Identifier
1437924669
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SPINE SPORTS SURGERY CENTER, LLC
Practice address
3803 S Bascom Ave Ste 106
Campbell, CA 95008-7317
Phone
(408) 520-4295
NPI assigned
Nov 17, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Authorized official

Name
Sherman Nam Tran, MDNPI 1063407302
Title
Owner/Manager
Phone
(408) 378-6773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

3803 S Bascom Ave Ste 106
Campbell, CA 95008-7317

Mailing address

429 Llewellyn Ave
Campbell, CA 95008-1948
Phone (408) 378-6773

Other names 1

  • Bascom Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240614000895 CA Part B Supplier - Ambulatory Surgical Center 4688730153 Practice locations: Campbell, CA

Ambulatory surgical center certification: CCN 05C0001538

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Bascom Surgery Center
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Feb 14, 2024
Last certification
Feb 14, 2024
Ownership / control type
Proprietary
Facility address
3803 South Bascom Avenue, Suite 106
Campbell, CA 95008

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Spine Sports Surgery Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member of 3

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

Locations

3803 S Bascom Ave
Campbell, CA 95008
Phone (408) 369-9535

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1700179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1437924669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "429 LLEWELLYN AVE",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950081948",
            "telephone_number": "408-378-6773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3803 S BASCOM AVE STE 106",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950087317",
            "telephone_number": "408-520-4295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE SPORTS SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-17",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "SHERMAN",
        "authorized_official_middle_name": "NAM",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "408-378-6773",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bascom Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bascom Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Campbell, CA

Sources for this page

Verify at the official NPI Registry.