NPIMap

Organization Active NPI

Bismarck Surgical Associates LLC

  • Certified Registered Nurse Anesthetist
  • Bismarck, ND
National Provider Identifier
1487814356
Registry record updated Oct 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R28938 Issued in ND
Legal business name
BISMARCK SURGICAL ASSOCIATES LLC
Practice address
106 E Greenfield LN
Bismarck, ND 58503-6578
Phone
(701) 221-2299
Fax
(701) 355-4331
NPI assigned
Jun 13, 2008
Last updated
Oct 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2019

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

Authorized official

Name
Dr. Attas Boutrous
Title
Administrator
Phone
(701) 221-2299

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X ND
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X R28938 ND Primary

Addresses

Primary practice location

106 E Greenfield LN
Bismarck, ND 58503-6578

Mailing address

106 E Greenfield LN
Bismarck, ND 58503-6578
Phone (701) 221-2299

Other identifiers 3

IdentifierTypeStateIssuer
8618OtherNDBCBS
10864MedicaidND
490004061OtherNDRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041004001040 ND Part B Supplier - Clinic/Group Practice 6800855099 Receives reassigned benefits from 15 practitioners
Practice locations: Bismarck, ND

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Bismarck Surgical Associates2 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.

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571875200000",
    "number": "1487814356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 E GREENFIELD LN",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585036578",
            "telephone_number": "701-221-2299",
            "fax_number": "701-323-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E GREENFIELD LN",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585036578",
            "telephone_number": "701-221-2299",
            "fax_number": "701-355-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BISMARCK SURGICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-13",
        "last_updated": "2019-10-24",
        "status": "A",
        "authorized_official_last_name": "BOUTROUS",
        "authorized_official_first_name": "ATTAS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "701-221-2299",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "ND",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "R28938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8618",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10864",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490004061",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.