Active NPI
Woodbury Surgery Center, LLC
- Ambulatory Surgical Clinic/Center
- Woodbury, MN
National Provider Identifier
1669079992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- Legal business name
- WOODBURY SURGERY CENTER, LLC
- Practice address
- 587 Bielenberg Dr Ste 100
Woodbury, MN 55125-4452 - Phone
- (651) 493-0343
- NPI assigned
- Oct 9, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Michael Miller
- Title
- Board Member
- Phone
- (651) 493-0343
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Primary |
Addresses
Primary practice location
587 Bielenberg Dr Ste 100
Woodbury, MN 55125-4452
Mailing address
587 Bielenberg Dr Ste 100
Woodbury, MN 55125-4452
Phone (651) 493-0343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210205000929 | MN | Part B Supplier - Ambulatory Surgical Center | 2264846088 | Practice locations: Woodbury, MN |
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Woodbury Surgery Center
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Woodbury Surgery Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Ambulatory Surgical Clinic/Center
- Woodbury, MN
- NPI 1699497727
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602201600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1602201600000",
"number": "1669079992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "587 BIELENBERG DR STE 100",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551254452",
"telephone_number": "651-493-0343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "587 BIELENBERG DR STE 100",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551254452",
"telephone_number": "651-493-0343"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WOODBURY SURGERY CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-10-09",
"last_updated": "2020-10-09",
"certification_date": "2020-10-09",
"status": "A",
"authorized_official_last_name": "MILLER",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "BOARD MEMBER",
"authorized_official_telephone_number": "651-493-0343",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.