Brockton Endoscopy Surgery Center LP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BROCKTON ENDOSCOPY SURGERY CENTER LP

Practice address

6958 Brockton Ave
Suite 100
Riverside, CA 92506-3829

Phone

(951) 788-4400

NPI assigned

May 3, 2007

Last updated

Oct 7, 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

Dr. Vinod Mishra, M.D.

Title

Medical Director

Phone

(951) 788-4400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Brockton Endoscopy Surgery Center LPCCN 05C0001818

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

Locations

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1447472659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6958 BROCKTON AVE",
            "address_2": "SUITE 100",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063829",
            "telephone_number": "951-788-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6958 BROCKTON AVE",
            "address_2": "SUITE 100",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063829",
            "telephone_number": "951-788-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON ENDOSCOPY SURGERY CENTER LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "MISHRA",
        "authorized_official_first_name": "VINOD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "951-788-4400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mireya Elizabeth Brocatto-Keck, LMFT
• Ronny Angeline Brock
• Brendon Douglas Brockmann, MD
• Lynne M Brockmeier
• Brockton Dental X-Ray Lab., Inc.
• Brockton Investments & Associates, LLC (Riverside Center for Behavioral Medicine)
• Brockton Surgical Center
• Divine Grace Fernandez Broich
• Aijalon Benet Brooks
• Byron Brooks, MHRS

• Ambulatory Surgical Clinic/Center in Riverside, CA
• Providers in Riverside, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.