NPIMap

Organization Active NPI

Waterford Surgical Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Waterford, MI
National Provider Identifier
1467788729
Registry record updated Oct 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
WATERFORD SURGICAL CENTER, LLC
Practice address
5220 Highland Rd
Suite 100
Waterford, MI 48327-1975
Phone
(248) 889-4580
Fax
(248) 889-4582
NPI assigned
Oct 21, 2009
Last updated
Oct 21, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2009

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

Authorized official

Name
Dr. Bashar Succar, M.D.
Title
Medical Director
Phone
(248) 889-4580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X MI Primary

Addresses

Primary practice location

5220 Highland Rd
Suite 100
Waterford, MI 48327-1975

Mailing address

5220 Highland Rd
Suite 100
Waterford, MI 48327-1975
Phone (248) 889-4580

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091230000073 MI Part B Supplier - Ambulatory Surgical Center 9234279019 Practice locations: Waterford, MI

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Waterford Surgical Center LLCCCN 23C0001093
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1069081Waterford Surgical Center5220 Highland Road Suite 100, Waterford, MI 48327Certificate of waiverDec 13, 2027

National Provider Directory

National Provider Directory

Member of 1

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

Locations

232687 Monument Pl
Chicago, IL 60689

Practitioners & affiliated clinicians

Practitioners 114

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 114

NPI Registry JSON

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

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256083200000",
    "number": "1467788729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 HIGHLAND RD",
            "address_2": "SUITE 100",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271975",
            "telephone_number": "248-889-4580",
            "fax_number": "248-889-4582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 HIGHLAND RD",
            "address_2": "SUITE 100",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271975",
            "telephone_number": "248-889-4580",
            "fax_number": "248-889-4582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-21",
        "last_updated": "2009-10-21",
        "status": "A",
        "authorized_official_last_name": "SUCCAR",
        "authorized_official_first_name": "BASHAR",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "248-889-4580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; 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.