NPIMap

Organization Active NPI

C. Rex Witherspoon Surgery Center Inc

  • Ambulatory Surgical Clinic/Center
  • Springfield, MO
National Provider Identifier
1629105770
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
148-1 Issued in MO
Legal business name
C. REX WITHERSPOON SURGERY CENTER INC
Practice address
1103 E Montclair St Ste 110
Springfield, MO 65807-5076
Phone
(417) 447-2482
Fax
(417) 447-2596
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Julie Ann Gipson, MBA, CASC
Title
Administrator
Phone
(417) 447-2482

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 148-1 MO Primary
Ambulatory Surgical Clinic/Center 261QA1903X

Addresses

Primary practice location

1103 E Montclair St Ste 110
Springfield, MO 65807-5076

Mailing address

1103 E Montclair St Ste 110
Springfield, MO 65807-5076
Phone (417) 447-2482

Other identifiers 1

IdentifierTypeStateIssuer
507189207MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050316000614 MO Part B Supplier - Ambulatory Surgical Center 7214982883 Practice locations: Springfield, MO

Ambulatory surgical center certification: CCN 26C0001090

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
The C. Rex Witherspoon Surgery Center, Inc.
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jan 20, 2005
Last certification
Oct 18, 2018
Ownership / control type
Proprietary
Facility address
1103 East Montclair Street, Suite 110
Springfield, MO 65807

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D1026751C Rex Witherspoon Surgery Center Inc1103 Montclair, Ste 110, Springfield, MO 65807Certificate of waiverJun 14, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1629105770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 E MONTCLAIR ST STE 110",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075076",
            "telephone_number": "417-447-2482",
            "fax_number": "417-447-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 E MONTCLAIR ST STE 110",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075076",
            "telephone_number": "417-447-2482",
            "fax_number": "417-447-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C. REX WITHERSPOON SURGERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "GIPSON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "417-447-2482",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA, CASC"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "148-1",
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507189207",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.