Mississippi Medical Plaza, LC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MISSISSIPPI MEDICAL PLAZA, LC

Doing business as

Mississippi Valley Surgery Center

Practice address

3400 Dexter CT
#200
Davenport, IA 52807-3461

Phone

(563) 344-6600

Fax

(563) 344-6699

NPI assigned

Apr 25, 2006

Last updated

Sep 19, 2014By 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

Susan K Lohf

Title

Manager

Phone

(563) 344-6600

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mississippi Valley Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IA2 enrollments

Enrollment records 2

Listed as

Mississippi Valley Endoscopy CenterCCN 16C0001007

Medicare certification status

ActiveFrom the Provider of Services file

Listed as

Mississippi Valley Endoscopy CenterCCN 16C0001023

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

Member of 1

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

• Trinity Medical Center

  dba Trinity Work Fitness

  • General Practice Physician
  • Moline, IL
  • NPI 1770699902

  Member Of

  NPD member

Practitioners 3

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.

• Bavikatte N Shivakumar, M.D.

  • Gastroenterology Physician
  • Davenport, IA
  • NPI 1043200835
  NPD (past)
• Chaudry Ahmad Waheed Cheema, M.D.

  • Gastroenterology Physician
  • Rock Island, IL
  • NPI 1659375343
  NPD (past)
• Poonputt Chotiprasidhi, M.D.

  • Gastroenterology Physician
  • Moline, IL
  • NPI 1558363713
  NPD (past)

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411084800000",
    "number": "1619933835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DEXTER CT",
            "address_2": "#200",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073461",
            "telephone_number": "563-344-6600",
            "fax_number": "563-344-6699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 DEXTER CT",
            "address_2": "#200",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073461",
            "telephone_number": "563-344-6600",
            "fax_number": "563-344-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI MEDICAL PLAZA, LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2014-09-19",
        "status": "A",
        "authorized_official_last_name": "LOHF",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "563-344-6600"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0143073",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mississippi Valley Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan V Mina
• Janel Delyn Miner, CNM
• Heather Faye Mink, CNM
• Janene Misak, PA-C
• Ashlee Misiag, ARNP
• Mississippi Valley Bariatrics
• Mississippi Valley Imaging, LLC
• Mississippi Valley Laboratory, LLC
• Mississippi Valley Oral & Maxillofacial Surgery PC
• Mississippi Valley Sleep Disorder Center LC (Mvsdc)

• Ambulatory Surgical Clinic/Center in Davenport, IA
• Providers in Davenport, IA by specialty
• Ambulatory Surgical Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2014; 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.