Southwest Connecticut Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTHWEST CONNECTICUT SURGERY CENTER, LLC

Practice address

60 Danbury Rd
Wilton, CT 06897-4406

Phone

(476) 257-6500

Fax

(475) 257-6520

NPI assigned

Dec 1, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Lucille Formeister

Title

Director Business Systems

Phone

(860) 667-9542

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Listed as

Southwest Connecticut Surgery Center LLCCCN 07C0001072

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 1

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

• Connecticut Orthopaedic Specialists, PC

  • Orthopaedic Surgery Physician
  • Branford, CT
  • NPI 1467656587

  Member Of

  NPD member

Practitioners 2

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

• Mark Gombotz

  • Physical Therapist
  • Old Lyme, CT
  • NPI 1922116185
  NPD
• Paul Protomastro, M.D.

  • Orthopaedic Hand Surgery Physician
  • Wilton, CT
  • NPI 1215936992
  NPD

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1467057372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1434",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060011434",
            "telephone_number": "860-667-3542",
            "fax_number": "860-667-2066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 DANBURY RD",
            "city": "WILTON",
            "state": "CT",
            "postal_code": "068974406",
            "telephone_number": "476-257-6500",
            "fax_number": "475-257-6520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST CONNECTICUT SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-01",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "FORMEISTER",
        "authorized_official_first_name": "LUCILLE",
        "authorized_official_title_or_position": "DIRECTOR BUSINESS SYSTEMS",
        "authorized_official_telephone_number": "860-667-9542",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Catharine Sommer, PTA
• David Sonatore, LCSW
• Michael G Soojian, MD
• Amber Mae Sosser, CD/PCD
• South Wilton Chiropractic PC
• Maura L Sparks, MD
• Spu Therapy, LLC
• Wallace Stacy Jr., LCSW
• Alexander Michael Stark, M.S., BCBA, LBA
• Charlene P Steffel

• Ambulatory Surgical Clinic/Center in Wilton, CT
• Providers in Wilton, CT by specialty
• Ambulatory Surgical Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.