Surgery Center of Idaho LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGERY CENTER OF IDAHO LLC

Practice address

2855 E Magic View Dr
Meridian, ID 83642-6245

Phone

(208) 639-4900

Fax

(208) 639-4919

NPI assigned

May 9, 2006

Last updated

Feb 22, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Todd Michael Waldmann, M.D.NPI 1104877299

Title

President

Phone

(208) 639-4900

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Member of 1

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

• Idaho Urologic Institute PA

  • Urology Physician
  • Meridian, ID
  • NPI 1689620692

  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, and the practitioner matching its NPPES authorized official.

• Todd M Waldmann, M.D.

  • Urology Physician
  • Meridian, ID
  • NPI 1104877299
  Authorized official Same address or phone

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1609825298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900",
            "fax_number": "208-639-4919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900",
            "fax_number": "208-639-4919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER OF IDAHO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "WALDMANN",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-639-4900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1870688",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807589100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD MERIDIAN",
            "identifier": "000010157600",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS MERIDIAN",
            "identifier": "04868",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunbridge Healthcare LLC (Meridian Center)
• Hannah Sundali
• Sunrise Home Health of Idaho
• Emma Marie Sunshaw, PHD, LPC
• Superior Vein Care, PLLP
• Surgical Center of TVH
• Marisue Susman, NP
• Rebekah M Svadlenka, NP
• SW Grant PC
• Marcia E Swain, CCC-SLP

• Ambulatory Surgical Clinic/Center in Meridian, ID
• Providers in Meridian, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.