Grand Avenue Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GRAND AVENUE SURGERY CENTER, LLC

Practice address

1400 S Grand Ave Ste 700
Los Angeles, CA 90015-3068

Phone

(213) 866-1900

Fax

(213) 275-1393

NPI assigned

Dec 16, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Greg Horner, MD

Title

Ceo

Phone

(925) 984-4734

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Grand Ave Surgery Center LLCCCN 05C0002280

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607040000000",
    "number": "1558832741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S GRAND AVE STE 700",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153068",
            "telephone_number": "213-866-1900",
            "fax_number": "213-275-1393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S GRAND AVE STE 700",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153068",
            "telephone_number": "213-866-1900",
            "fax_number": "213-275-1393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND AVENUE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A",
        "authorized_official_last_name": "HORNER",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "925-984-4734",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Isabelle Granados
• Anna Granat
• Grancare LLC (Skyline Healthcare Center - Los Angeles)
• Grand Anesthesia and Nursing Services Inc
• Grand Avenue Imaging
• Grand Gi & Endoscopy Group, Inc. (Yonsei Endoscopy Center)
• Grand Gi & Endoscopy Group, Inc. (Grand Endoscopy Center)
• Grand Park SNF Operator LLC
• Grand Pharmacy., Inc
• Grand Pharmacy., Inc

• Ambulatory Surgical Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.