Center for Surgery PLLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

CENTER FOR SURGERY PLLC

Practice address

3369 Merlin Dr Ste a
Idaho Falls, ID 83404-7405

Phone

(208) 524-8600

NPI assigned

Nov 11, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Gary W. Wallace, MDNPI 1144335290

Title

Medical Director

Phone

(208) 524-8600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Listed as

Center for Surgery PLLCCCN 13C0001086

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

Practitioners 1

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

• Gary Wayne Wallace, M.D.

  • Ophthalmology Physician
  • Idaho Falls, ID
  • NPI 1144335290
  NPD Authorized official

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574640000000",
    "number": "1467097725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3369 MERLIN DR STE A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3369 MERLIN DR STE A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047405",
            "telephone_number": "208-524-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-11",
        "last_updated": "2019-11-25",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "208-524-8600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Celebration Speech Inc
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• Center for Aesthetics PC
• Center for Sight PLLC
• Center for Vision and Learning, PLLC
• Maria Teresa Cervantes-Fullmer, FNP
• Chamberlain General Surgery PA
• David J Chamberlain, D.O.
• John D Chambers Jr., M.D.

• Ambulatory Surgical Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; 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.