NPIMap

Organization Active NPI

The Retina Surgery Center LLC

Doing business as The Retina Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Bellevue, WA
National Provider Identifier
1457670648
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
PENDING Issued in WA
Legal business name
THE RETINA SURGERY CENTER LLC
Doing business as
The Retina Surgery Center
Practice address
1750 112TH Ave NE Ste D050
Bellevue, WA 98004-3779
Phone
(206) 215-3850
Fax
(206) 215-3870
NPI assigned
May 27, 2010
Last updated
Aug 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Dr. David SapersteinNPI 1508946625
Title
MD
Phone
(206) 215-3850

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 PENDING WA Primary

Addresses

Primary practice location

1750 112TH Ave NE Ste D050
Bellevue, WA 98004-3779

Mailing address

22232 17TH Ave SE Ste 308
Bothell, WA 98021-7425
Phone (206) 215-3850

Other identifiers 1

IdentifierTypeStateIssuer
2016389MedicaidWA

Other names 1

  • The Retina Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210726002844 WA Part B Supplier - Ambulatory Surgical Center 0749683944 Practice locations: Bellevue, WA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Proliance Surgeons Inc PSCCN 50C0001297
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 1

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

Locations

2821 Northup Way
Ste 200
Bellevue, WA 98004
Phone (425) 576-0225

22232 17th Ave SE
Ste 308
Bothell, WA 98021

215 E George Hopper Rd
Burlington, WA 98233

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1457670648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22232 17TH AVE SE STE 308",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980217425",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 112TH AVE NE STE D050",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043779",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RETINA SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "SAPERSTEIN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "206-215-3850",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2016389",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Retina Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Retina Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.