Kokomo Ambulatory Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

KOKOMO AMBULATORY SURGERY CENTER

Practice address

107 S Washington St Ste a
Kokomo, IN 46901-4601

Phone

(765) 450-6735

Fax

(765) 838-3200

NPI assigned

Feb 19, 2018

Organization subpart

No

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

Authorized official

Name

Shazia M Siddiqui, MDNPI 1629001680

Title

Owner

Phone

(765) 450-6735

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

Kokomo Ambulatory Surgery Center LLCCCN 15C0001206

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 2

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

• Shazia Meraj Siddiqui, MD

  • Pain Medicine (Anesthesiology) Physician
  • Lafayette, IN
  • NPI 1629001680
  NPD Authorized official
• Laura Faye Peacock, NP

  • Family Nurse Practitioner
  • Lafayette, IN
  • NPI 1144763855
  NPD (past)

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

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518998400000",
    "number": "1609376409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5748",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479035748",
            "telephone_number": "765-714-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 S WASHINGTON ST STE A",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469014601",
            "telephone_number": "765-450-6735",
            "fax_number": "765-838-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOKOMO AMBULATORY SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-19",
        "last_updated": "2018-02-19",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUI",
        "authorized_official_first_name": "SHAZIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-450-6735",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenner Knowles
• Hannah Degroot Koch, OD
• Michael G Koelsch, MD
• Rachel Koh, DDS
• Kokomo Academy
• Kokomo Anesthesia Services Inc
• Kokomo BG Opco LLC
• Kokomo Cab LLC
• Kokomo Center for Outpatient Surgery LLC
• Kokomo Chiropractic Care, PC

• Ambulatory Surgical Clinic/Center in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2018; 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.