Summit Surgery Center Modesto, Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SUMMIT SURGERY CENTER MODESTO, INC

Practice address

654 Lyell Dr
Modesto, CA 95356-8997

Phone

(209) 521-9661

Fax

(209) 521-2640

NPI assigned

Aug 29, 2019

Last updated

Feb 28, 2020By 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

Dr. Rajesh Kumar Dubey, MDNPI 1225011299

Title

Managing Partner

Phone

(209) 918-5181

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619525912. Details of each certification follow.

• CCN 05C0002259 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 05C0002259

Legal name

SUMMIT SURGERY CENTER MODESTO

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Mar 9, 2021

Last certification

Mar 9, 2021

Ownership / control type

Proprietary

Facility address

654 Lyell Drive Suite B
Modesto, CA 95356

Locations

Practitioners 6

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.

• Rajesh Kumar Dubey, M.D.

  • Cardiovascular Disease Physician
  • Modesto, CA
  • NPI 1225011299
  NPD (past) Authorized official
• Hassan Mohamed Hussain, MD

  • Cardiovascular Disease Physician
  • Modesto, CA
  • NPI 1962485938
  NPD
• Kent Hon-Wah Wong, MD

  • Cardiovascular Disease Physician
  • Modesto, CA
  • NPI 1386628212
  NPD
• Joydev Acharya, MD

  • Specialist
  • Modesto, CA
  • NPI 1801898044
  NPD (past)
• Mutahir Ubaid Khan, M.D.

  • Cardiovascular Disease Physician
  • Modesto, CA
  • NPI 1164734489
  NPD (past)
• Maereg Wassie, M.D

  • Interventional Cardiology Physician
  • La Jolla, CA
  • NPI 1730533506
  NPD (past)

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

{
    "created_epoch": "1567036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582848000000",
    "number": "1619525912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 FOREST GLENN DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551339",
            "telephone_number": "209-521-9661",
            "fax_number": "209-521-2640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 LYELL DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568997",
            "telephone_number": "209-521-9661",
            "fax_number": "209-521-2640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT SURGERY CENTER MODESTO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-29",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A",
        "authorized_official_last_name": "DUBEY",
        "authorized_official_first_name": "RAJESH",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "209-918-5181",
        "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": []
}

• Ravi Sumer, MD
• Mary Jessie Sumithra, M.D
• Leena M Sumitra
• James Bradley Summers, M.D.
• Summit Medical Transport
• Zarchi E Sumon, M.D.
• Heather J Sumpter
• Sun Ik Lee MD Inc a Professional Medical Corporation
• Chelsea Sun
• Penghan Sun

• Ambulatory Surgical Clinic/Center in Modesto, CA
• Providers in Modesto, 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 Feb 28, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.