NPIMap

Organization Active NPI

Saint Charles Surgical Pavilion Inc

  • Ambulatory Surgical Clinic/Center
  • Jasper, IN
National Provider Identifier
1477513844
Registry record updated Jan 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
060025231 Issued in IN
Legal business name
SAINT CHARLES SURGICAL PAVILION INC
Practice address
1900 Saint Charles Street
Jasper, IN 47546-9145
Phone
(812) 634-1211
Fax
(812) 634-9762
NPI assigned
Mar 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2012

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

Authorized official

Name
Randall Gene Norris, MDNPI 1447211321
Title
Owner Ceo
Phone
(812) 634-1211

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 060025231 IN Primary

Addresses

Primary practice location

1900 Saint Charles Street
Jasper, IN 47546-9145

Mailing address

1900 Saint Charles Street
Jasper, IN 47546-9145
Phone (812) 634-1211

Other identifiers 1

IdentifierTypeStateIssuer
200318370AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120117000760 IN Part B Supplier - Ambulatory Surgical Center 7719872340 Practice locations: Jasper, IN

National Provider Directory

National Provider Directory
Tax ID family
Saint Charles Surgical Pavilion2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 6

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Saint Charles Surgical PavilionCCN 15C0001103
Medicare certification status
ActiveFrom the Provider of Services file

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326412800000",
    "number": "1477513844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SAINT CHARLES STREET",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475469145",
            "telephone_number": "812-634-1211",
            "fax_number": "812-634-9762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SAINT CHARLES STREET",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475469145",
            "telephone_number": "812-634-1211",
            "fax_number": "812-634-9762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT CHARLES SURGICAL PAVILION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2012-01-13",
        "status": "A",
        "authorized_official_last_name": "NORRIS",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "OWNER CEO",
        "authorized_official_telephone_number": "812-634-1211",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "060025231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200318370A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; 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.