St. Augustine Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ST. AUGUSTINE AMBULATORY SURGERY CENTER, LLC

Practice address

45 Groover Loop
St Augustine, FL 32086-6548

Phone

(904) 648-8660

NPI assigned

Aug 22, 2025

Organization subpart

No

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

Authorized official

Name

Robert Haen

Title

Executive Director

Phone

(904) 648-8660

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Ambulatory surgical center certification: CCN 10C0001784

Legal name

ST AUGUSTINE AMBULATORY SURGERY CENTER LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Apr 14, 2026

Last certification

Apr 14, 2026

Facility address

45 Groover Loop
Saint Augustine, FL 32086

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1755820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755820800000",
    "number": "1598643140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 GROOVER LOOP",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "320866548",
            "telephone_number": "904-648-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 GROOVER LOOP",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866548",
            "telephone_number": "904-648-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. AUGUSTINE AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-22",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A",
        "authorized_official_last_name": "HAEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-648-8660"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.