Centennial ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

008203 Issued in TX

Legal business name

CENTENNIAL ASC, LLC

Doing business as

Baylor Surgicare at Centennial

Practice address

4401 Coit Rd
Suite 100
Frisco, TX 75035

Phone

(214) 619-0120

Fax

(214) 619-0121

NPI assigned

Mar 1, 2006

Last updated

Sep 18, 2024By 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

Donita Fleming

Title

Officer / Authorized Official

Phone

(202) 815-3665

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Baylor Surgicare at Centennial Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Centennial ASC LLCCCN 45C0001396

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 2

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

• Baylor University Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Dallas, TX
  • NPI 1518967231

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  dba Baptist Health System

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1639146541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 COIT RD",
            "address_2": "SUITE 100",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750350500",
            "telephone_number": "214-619-0120",
            "fax_number": "214-619-0121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 COIT RD",
            "address_2": "SUITE 100",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "75035",
            "telephone_number": "214-619-0120",
            "fax_number": "214-619-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "FLEMING",
        "authorized_official_first_name": "DONITA",
        "authorized_official_title_or_position": "OFFICER / AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "202-815-3665"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "008203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TX",
            "identifier": "HH065A",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00617261",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Baylor Surgicare at Centennial",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baylor Surgicare at Centennial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• CCRM DFW, LLC (CCRM Dallas Fort Worth)
• CDS at State Care Agency LLC
• Ryan W Cecil, DC
• Cedarleaf Anesthesia LLC (Cedarleaf Anesthesia)
• Celebrity Home Care
• Centennial OB GYN PA
• Centennial OB GYN, P.a.
• Centennial Pediatrics
• Centennial Primary Care PLLC
• Center for Assisted Reproduction

• Ambulatory Surgical Clinic/Center in Frisco, TX
• Providers in Frisco, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.