Prince William Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

OH695 Issued in VA

Legal business name

PRINCE WILLIAM AMBULATORY SURGERY CENTER, LLC

Practice address

8644 Sudley Rd
Suite 201
Manassas, VA 20110-4417

Phone

(703) 369-8525

Fax

(571) 229-1533

NPI assigned

Aug 7, 2006

Organization subpart

No

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

Authorized official

Name

Kristen O'Connor

Title

Officer / Authorized Official

Phone

(615) 376-7315

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Prince William Surgery Center Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Listed as

Prince William Ambulatory Surgery CenterCCN 49C0001039

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

Member of 4

Organizations this organization is a member of, according to the National Provider Directory.

• Rector & Visitors of the University of Virginia

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Staunton, VA
  • NPI 1407212954

  Member Of

  NPD member
• Uva Prince William Medical Center

  • General Acute Care Hospital
  • Manassas, VA
  • NPI 1205987898

  Member Of

  NPD member
• Baylor University Medical Center

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1447250253

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

Practitioners 1

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

• Joanne Gutliph, M.D.

  • Gynecology Physician
  • Manassas, VA
  • NPI 1639151319
  NPD (past)

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728604800000",
    "number": "1528077658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8644 SUDLEY RD",
            "address_2": "SUITE 201",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104417",
            "telephone_number": "703-369-8525",
            "fax_number": "571-229-1533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8644 SUDLEY RD",
            "address_2": "SUITE 201",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104417",
            "telephone_number": "703-369-8525",
            "fax_number": "571-229-1533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE WILLIAM AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "OFFICER / AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-376-7315"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "VA",
            "license": "OH695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "2579620",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9731258",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDIPA/OPTIMUM CHOICE",
            "identifier": "2142411",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010274656",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM HEALTHKEEPERS",
            "identifier": "186080",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "186080",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI/UHC",
            "identifier": "2142411",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Prince William Surgery Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Prince William Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Victoria Stames Price, MA
• Primary Care Medicine LLC
• Janine Prime, NP
• Primedoc of Manassas PC
• Prince Wiliam Family Counseling, PC
• Prince William Cardiology Associates
• Prince William Community Services
• Prince William County Community Services Board
• Prince William County Community Services Board
• Prince William County Community Services Board

• Ambulatory Surgical Clinic/Center in Manassas, VA
• Providers in Manassas, VA by specialty
• Ambulatory Surgical Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.