NPIMap

Organization Active NPI

PCCC Surgery Center Inc.

  • Ambulatory Surgical Clinic/Center
  • Fresno, CA
National Provider Identifier
1639896384
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PCCC SURGERY CENTER INC.
Practice address
5771 N Fresno St Ste 101
Fresno, CA 93710-6091
Phone
(833) 478-1818
NPI assigned
Oct 24, 2022
Last updated
Jan 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

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

Authorized official

Name
Lorraine Hernandez
Title
Administrator
Phone
(833) 478-1818

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

5771 N Fresno St Ste 101
Fresno, CA 93710-6091

Mailing address

3550 Q St Ste 304B
Bakersfield, CA 93301-1662
Phone (833) 478-1818

Other practice location 1

1130 Coffee Rd Bldg 5B
Modesto, CA 95355-4228
Phone (833) 478-1818

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lhernandez@painclinicscc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20230810001118 CA Part B Supplier - Clinic/Group Practice 3274995048 Receives reassigned benefits from 9 practitioners
Practice locations: Modesto, CA; Fresno, CA
O20231025001149 CA Part B Supplier - Ambulatory Surgical Center 3274995048 Receives reassigned benefits from 7 practitioners
Practice locations: Modesto, CA
O20260318001778 CA Part B Supplier - Ambulatory Surgical Center 3274995048 Receives reassigned benefits from 2 practitioners
Practice locations: Fresno, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1639896384. Details of each certification follow.

Ambulatory surgical center certification: CCN 55C0001208

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
PCCC Surgery Center Inc
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Oct 18, 2024
Last certification
Aug 15, 2024
Facility address
1130 Coffee Road Building 5B
Modesto, CA 95355

Ambulatory surgical center certification: CCN 55C0001230

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
PCCC Surgery Center Inc.
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jan 21, 2024
Last certification
Nov 17, 2023
Facility address
5771 N. Fresno St., Ste. 101
Fresno, CA 93710

National Provider Directory

National Provider Directory

Locations

3550 Q St
Ste 304B
Bakersfield, CA 93301

3550 Q St
Ste 304C
Bakersfield, CA 93301
Phone (833) 906-0207

Interoperability endpoints

  • Direct secure messaging: lhernandez@painclinicscc.com

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735776000000",
    "number": "1639896384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 Q ST STE 304B",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933011662",
            "telephone_number": "833-478-1818",
            "fax_number": "833-478-1817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5771 N FRESNO ST STE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937106091",
            "telephone_number": "833-478-1818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1130 Coffee Rd Bldg 5B",
            "address_purpose": "LOCATION",
            "city": "Modesto",
            "state": "CA",
            "postal_code": "953554228",
            "country_code": "US",
            "telephone_number": "833-478-1818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PCCC SURGERY CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-24",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "LORRAINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "833-478-1818"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lhernandez@painclinicscc.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3550 Q St Ste 304B",
            "city": "Bakersfield",
            "state": "CA",
            "country_code": "US",
            "postal_code": "933011662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.