Active NPI
Waverley Surgery Center LLC
- Ambulatory Surgical Clinic/Center
- Palo Alto, CA
National Provider Identifier
1619944824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- License
- 220000472
- Legal business name
- WAVERLEY SURGERY CENTER LLC
- Doing business as
- Waverley Surgery Center
- Practice address
- 400 Forest Ave
Palo Alto, CA 94301-2608 - Phone
- (650) 324-0600
- Fax
- (650) 289-1620
- NPI assigned
- Mar 7, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jeffrey Snodgrass
- Title
- President of LLC
- Phone
- (615) 263-4011
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 220000472 | CA | Primary |
Addresses
Primary practice location
400 Forest Ave
Palo Alto, CA 94301-2608
Mailing address
1A Burton Hills Blvd
Attn: L&C
Nashville, TN 37215-6187
Phone (615) 240-3820
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SUR01547F | Other | CA | MEDICAL |
Other names 1
- Waverley Surgery Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050712000817 | CA | Part B Supplier - Ambulatory Surgical Center | 6406882380 | Practice locations: Palo Alto, CA |
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Waverley Surgery Center LLC
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141689600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1666137600000",
"number": "1619944824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1A BURTON HILLS BLVD",
"address_2": "ATTN: L&C",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372156187",
"telephone_number": "615-240-3820",
"fax_number": "615-234-1720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 FOREST AVE",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943012608",
"telephone_number": "650-324-0600",
"fax_number": "650-289-1620"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAVERLEY SURGERY CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-07",
"last_updated": "2022-10-19",
"certification_date": "2022-10-19",
"status": "A",
"authorized_official_last_name": "SNODGRASS",
"authorized_official_first_name": "JEFFREY",
"authorized_official_title_or_position": "PRESIDENT OF LLC",
"authorized_official_telephone_number": "615-263-4011",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": "CA",
"license": "220000472",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "SUR01547F",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Waverley Surgery Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; 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.