Newco Ambulatory Surgery Center, LLP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

746818 Issued in MI

Legal business name

NEWCO AMBULATORY SURGERY CENTER, LLP

Doing business as

Lakeshore Surgery Center, LLP

Practice address

4190 24TH Ave
Fort Gratiot, MI 48059-3882

Phone

(810) 989-7649

Fax

(810) 989-7652

NPI assigned

Aug 2, 2005

Last updated

Aug 22, 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

Mr. Timothy P Connell

Title

Administrator

Phone

(810) 989-7751

Specialties & licenses 1

Addresses

Other identifiers 8

Other names 1

• LAKESHORE SURGERY CENTER, LLP Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Newco Ambulatory Surgery Center LLPCCN 23C0001052

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

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

• Prime Healthcare Services-Port Huron LLC

  • General Acute Care Hospital
  • Port Huron, MI
  • NPI 1306227764

  Member Of

  NPD member

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Lakeshore Surgery Anesthesia Billing

  • Certified Registered Nurse Anesthetist
  • Fort Gratiot, MI
  • NPI 1417706342

  Member Of

  NPD member

Locations

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.

• Edward Michael Balok, M.D.

  • Ophthalmology Physician
  • East China, MI
  • NPI 1609884220
  NPD (past)

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629079611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593882",
            "fax_number": "810-989-7652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593882",
            "telephone_number": "810-989-7649",
            "fax_number": "810-989-7652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWCO AMBULATORY SURGERY CENTER, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONNELL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "810-989-7751",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": "746818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HEALTH PLAN",
            "identifier": "143728",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4563971",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICES",
            "identifier": "139016",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "30036708",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "40221",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "139016",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN OF MICHIGAN",
            "identifier": "32463",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "40221",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKESHORE SURGERY CENTER, LLP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dev S Nandamudi, M.D.
• Farrukh Zaman Naqvi, M.D.
• Janet Marie Natzke
• Paeton Neil
• Neurosleep Center PLLC
• Newco Ambulatory Surgery Center, LLP
• Greta Amaris Nichols, LBASW
• Kelsey Elaine Noble
• Michael Gerard Noble, COTA MLD
• Nurtureher, PLLC

• Ambulatory Surgical Clinic/Center in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.