NPIMap

Organization Active NPI

Surgery Center of Eye Specialists of Indiana, PC

  • Ambulatory Surgical Clinic/Center
  • Indianapolis, IN
National Provider Identifier
1477633071
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
50003654A Issued in IN
Legal business name
SURGERY CENTER OF EYE SPECIALISTS OF INDIANA, PC
Practice address
1901 North Meridian Street
Indianapolis, IN 46202
Phone
(317) 925-2200
Fax
(317) 921-6614
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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

Authorized official

Name
Paul Louis WaltonNPI 1912905423
Title
Ceo/ Owner
Phone
(317) 925-2200

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 50003654A IN Primary

Addresses

Primary practice location

1901 North Meridian Street
Indianapolis, IN 46202

Mailing address

1901 North Meridian Street
Indianapolis, IN 46202
Phone (317) 925-2200

Other identifiers 2

IdentifierTypeStateIssuer
000000098114OtherBLUE CROSS BLUE SHIELD
100103070AMedicaidIN

Other names 1

  • Surgery Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091111000395 IN Part B Supplier - Ambulatory Surgical Center 7315085362 Practice locations: Indianapolis, IN

Ambulatory surgical center certification: CCN 15C0001027

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SURGERY CENTER OF EYE SPECIALISTS OF INDIANA
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Apr 5, 1991
Last certification
Feb 17, 2021
Ownership / control type
Proprietary
Facility address
1901 N Meridian St
Indianapolis, IN 46202

Other NPIs with the same Medicare PAC ID 1

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

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
15D0881664Surgery Ctr of Eye Specialist of in PC1901 N Meridian St, Indianapolis, IN 46202Certificate of waiverJan 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
Eye Specialists of Indiana2 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.

Locations

2020 W 86th St
Indianapolis, IN 46260
Phone (317) 871-5900

1950 N Meridian St
Indianapolis, IN 46202

3530 S Keystone Ave
Indianapolis, IN 46227
Phone (317) 925-2200

1828 N Meridian St
Indianapolis, IN 46202

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1477633071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 NORTH MERIDIAN STREET",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46202",
            "telephone_number": "317-925-2200",
            "fax_number": "317-921-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 NORTH MERIDIAN STREET",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46202",
            "telephone_number": "317-925-2200",
            "fax_number": "317-921-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER OF EYE SPECIALISTS OF INDIANA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "CEO/ OWNER",
        "authorized_official_telephone_number": "317-925-2200"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "50003654A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000098114",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100103070A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgery Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.