Active NPI
Novamed Eye Surgery Center of Overland Park, LLC
- Ambulatory Surgical Clinic/Center
- Overland Park, KS
National Provider Identifier
1629078043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- License
- S-046-005
- Legal business name
- NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, LLC
- Practice address
- 5520 College Blvd
Suite 200
Overland Park, KS 66211-1630 - Phone
- (913) 491-3040
- Fax
- (913) 491-3640
- NPI assigned
- Jul 28, 2005
- 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
- Jennifer Boyd Baldock
- Title
- Officer and Authorized Official
- Phone
- (615) 234-5900
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | S-046-005 | KS | Primary |
Addresses
Primary practice location
5520 College Blvd
Suite 200
Overland Park, KS 66211-1630
Mailing address
5520 College Blvd
Suite 200
Overland Park, KS 66211-1630
Phone (913) 491-3040
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 490003071 | Other | RR MEDICARE | |
| 100279090A | Medicaid | KS | |
| 508157302 | Medicaid | MO |
Other names 1
- Overland Park Surgery Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040401000173 | KS | Part B Supplier - Ambulatory Surgical Center | 7012909872 | Practice locations: Overland Park, KS |
| O20051109001232 | KS | Part B Supplier - Clinic/Group Practice | 7012909872 |
Receives reassigned benefits from 31 practitioners 1 other NPI on this enrollment Practice locations: Overland Park, KS |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Certified Registered Nurse Anesthetist
- Overland Park, KS
- NPI 1285755330
O20051109001232
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Novamed Eye Surgery Center of Overland Park LLC
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Novamed Eye SRG Ctrov PK Prof Fee
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Certified Registered Nurse Anesthetist
- Overland Park, KS
- NPI 1285755330
Locations
12239 Collections Cntr Dr
Chicago, IL 60693
5520 College Blvd
Ste 200
Overland Park, KS 66211
Phone (913) 491-3040
Practitioners & affiliated clinicians
Practitioners 33
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Certified Registered Nurse Anesthetist
- Independence, MO
- NPI 1043297252
KS
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122508800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1602547200000",
"number": "1629078043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5520 COLLEGE BLVD",
"address_2": "SUITE 200",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662111630",
"telephone_number": "913-491-3040",
"fax_number": "913-491-3640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5520 COLLEGE BLVD",
"address_2": "SUITE 200",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662111630",
"telephone_number": "913-491-3040",
"fax_number": "913-491-3640"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-07-28",
"last_updated": "2020-10-13",
"certification_date": "2020-10-13",
"status": "A",
"authorized_official_last_name": "BALDOCK",
"authorized_official_first_name": "JENNIFER",
"authorized_official_middle_name": "BOYD",
"authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
"authorized_official_telephone_number": "615-234-5900"
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": "KS",
"license": "S-046-005",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "490003071",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100279090A",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "508157302",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Overland Park Surgery Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Overland Park Surgery Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.