St Cloud MN Ophthalmology ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

331176 Issued in MN

Legal business name

ST CLOUD MN OPHTHALMOLOGY ASC LLC

Practice address

2055 15TH St N
Suite B
Saint Cloud, MN 56303-1747

Phone

(320) 258-6620

Fax

(320) 258-6622

NPI assigned

Jun 1, 2006

Organization subpart

No

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

Authorized official

Name

Jeffrey E Snodgrass

Title

President

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St. Cloud Center for Ophthalmic Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Listed as

St Cloud Center for Opthalmic SurgeryCCN 24C0001039

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.

• Richard William Lucius, MD

  • Ophthalmology Physician
  • Saint Cloud, MN
  • NPI 1083602783
  NPD (past)

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669161600000",
    "number": "1467499293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1A BURTON HILLS BLVD # L&C",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156187",
            "telephone_number": "615-665-1283",
            "fax_number": "615-234-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 15TH ST N",
            "address_2": "SUITE B",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031747",
            "telephone_number": "320-258-6620",
            "fax_number": "320-258-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLOUD MN OPHTHALMOLOGY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "SNODGRASS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MN",
            "license": "331176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "837620400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Cloud Center for Ophthalmic Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Cloud Center for Ophthalmic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St Cloud Hospital
• St Cloud Hospital
• St Cloud Medical Group PA
• St Cloud Metro Taxi Inc
• St Cloud Metro Transportation LLC
• St Cloud Opticians
• St Cloud Outpatient Surgery LTD
• St Cloud Outpatient Surgery LTD
• St Cloud Pathologists PA
• Sara Gudrun St Hilaire, FNP-C

• Ambulatory Surgical Clinic/Center in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Ambulatory Surgical Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; 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.