Four States Surgery Center, PC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

157-1 Issued in MO

Legal business name

FOUR STATES SURGERY CENTER, PC

Practice address

1905 W 32ND St Ste 201
Joplin, MO 64804-1512

Phone

(417) 206-7900

Fax

(417) 206-3871

NPI assigned

May 27, 2006

Organization subpart

No

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

Authorized official

Name

Mindy Randles

Title

Director of Rev Cycle

Phone

(417) 887-3900

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Four States Surgery Center, Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Listed as

Four State Surgery CenterCCN 26C0001053

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 2

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

• Andrew R Osborn, MD

  • Ophthalmology Physician
  • Springfield, MO
  • NPI 1811493729
  NPD (past)
• Daniel R Osborn, M.D.

  • Ophthalmology Physician
  • Springfield, MO
  • NPI 1093701211
  NPD (past)

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1508813627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 EAST BRADFORD PARKWAY STE 100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658046539",
            "telephone_number": "417-887-3900",
            "fax_number": "417-823-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 W 32ND ST STE 201",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041512",
            "telephone_number": "417-206-7900",
            "fax_number": "417-206-3871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR STATES SURGERY CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "RANDLES",
        "authorized_official_first_name": "MINDY",
        "authorized_official_title_or_position": "DIRECTOR OF REV CYCLE",
        "authorized_official_telephone_number": "417-887-3900"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "157-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M4120R05",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504769902",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "67868614-01",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four States Surgery Center,",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Four State Regional Dialysis Center, Inc.
• Four State Regional Dialysis Center, Inc.
• Four States Anesthesia Services LLC
• Four States Hearing Center LLC
• Four States Pain Relief Institute, LLC
• Becky Fowkes
• Frank W. Shagets, Jr., M.D., P.C.
• Christa Nicole Frazier, PHARM D
• Ericka Freeborn
• Blair Joelle Freed, DO

• Ambulatory Surgical Clinic/Center in Joplin, MO
• Providers in Joplin, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; 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.