Advanced Surgical Technology, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ADVANCED SURGICAL TECHNOLOGY, LLC

Doing business as

AST Primary Care West Frankfort

Practice address

309 W Saint Louis St Ste a
West Frankfort, IL 62896-2047

Phone

(618) 932-9313

Fax

(618) 932-9314

NPI assigned

Jun 30, 2023

Last updated

Jun 30, 2023By 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

Jennia Rensing

Title

Office Manager

Phone

(618) 899-9200

Specialties & licenses 1

Addresses

Other names 1

• AST Primary Care West Frankfort Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649957648. Details of each certification follow.

• CCN 783864 Rural health clinic · Active · Name & address match · Details

Rural health clinic certification: CCN 783864

Legal name

AST PRIMARY CARE WEST FRANKFORT

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Feb 15, 2024

Last certification

Feb 15, 2024

Ownership / control type

1B

Facility address

309 W Saint Louis St Ste a
West Frankfort, IL 62896

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1649957648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 W SAINT LOUIS ST STE A",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628962047",
            "telephone_number": "618-932-9313",
            "fax_number": "618-932-9314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 W SAINT LOUIS ST STE A",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628962047",
            "telephone_number": "618-932-9313",
            "fax_number": "618-932-9314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SURGICAL TECHNOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "RENSING",
        "authorized_official_first_name": "JENNIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-899-9200"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AST Primary Care West Frankfort",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Aaron, LCSW
• Lauren Elizabeth Adams
• Adkins Family Practice, LLC
• Allyson Leigh Adkins, PTA
• Jon Adkins, M.ED., QMHP
• Hind Al-Sharif, M.D.
• Robert Ames
• Amy Broy Dba Developmental Therapy Services
• Robert L Andrews
• Jason L Antoine

• Rural Health Clinic/Center in West Frankfort, IL
• Providers in West Frankfort, IL by specialty
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.