South Shore SC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTH SHORE SC, LLC

Practice address

53 Brentwood Rd
Bay Shore, NY 11706-6923

Phone

(781) 733-2235

Fax

(973) 506-1887

NPI assigned

Feb 9, 2009

Organization subpart

No

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

Authorized official

Name

Wendy Nil Martinez, RN

Title

Facility Administrator

Phone

(631) 647-5550

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Listed as

South Shore SC LLCCCN 33C0001112

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.

• Luis M Fandos, M.D.

  • Interventional Pain Medicine Physician
  • Babylon, NY
  • NPI 1376572594
  NPD (past)

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

{
    "created_epoch": "1234137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1508005976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 BRENTWOOD RD STE F",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117066943",
            "telephone_number": "631-647-5550",
            "fax_number": "631-647-5549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 BRENTWOOD RD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117066923",
            "telephone_number": "781-733-2235",
            "fax_number": "973-506-1887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE SC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-09",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "NIL",
        "authorized_official_title_or_position": "FACILITY ADMINISTRATOR",
        "authorized_official_telephone_number": "631-647-5550",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Shore Bay Shore Medical PC
• South Shore Counseling Services of Certified Social Workers, PLLC
• South Shore Faculty Medical Affiliates, University Faculty Practice Co
• South Shore Infectious Diseases , PC
• South Shore Psychiatric Nurse Practitioner Group
• South Shore Surgical Consulting PC
• South Shore University Hospital
• South Shore University Hospital
• South Shore University Hospital
• Southshore Medical Practice Management, Inc

• Ambulatory Surgical Clinic/Center in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Ambulatory Surgical Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.