Gold Coast Surgicenter, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

7003150 Issued in IL

Legal business name

GOLD COAST SURGICENTER, LLC

Practice address

845 N Michigan Ave
Suite 985 West
Chicago, IL 60611-2252

Phone

(312) 521-5500

Fax

(312) 202-0492

NPI assigned

Jul 23, 2010

Organization subpart

No

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

Authorized official

Name

Jennifer Boyd Baldock

Title

Officer and Authorized Official

Phone

(615) 234-5954

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Gold Coast SurgicenterCCN 14C0001154

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

Locations

Practitioners 1

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

• Robert Wysocki, MD

  • Orthopaedic Surgery Physician
  • Chicago, IL
  • NPI 1275645319
  NPD (past)

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

{
    "created_epoch": "1279843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1578876124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N MICHIGAN AVE",
            "address_2": "SUITE 985 WEST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112252",
            "telephone_number": "312-521-5500",
            "fax_number": "312-202-0492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N MICHIGAN AVE",
            "address_2": "SUITE 985 WEST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112252",
            "telephone_number": "312-521-5500",
            "fax_number": "312-202-0492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLD COAST SURGICENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-23",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7003150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gold Coast Plastic Surgery LLC
• Gold Coast Podiatry Center, LLC
• Gold Coast Podiatry Center, LLC
• Gold Coast Podiatry Center, LLC
• Gold Coast Podiatry Center, LLC
• Gold Coast Wellness Center LTD.
• Gold Management Inc
• Gold Naprapathic & Wellness Center, PC
• Gold Standard Healthcare Inc
• Rebecca L Gold-Stein, PSY.D.

• Ambulatory Surgical Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.