Pacificoast Ambulatory Surgicenter, LLC.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

18448 Issued in CA

Legal business name

PACIFICOAST AMBULATORY SURGICENTER, LLC.

Practice address

665 Camino de Los Mares
Suite 100C
San Clemente, CA 92673-2859

Phone

(949) 481-7760

NPI assigned

Jul 10, 2006

Organization subpart

No

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

Authorized official

Name

Chris Gangnes

Title

General Manager

Phone

(949) 276-4141

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pacific Coast Ambulatory Surgicenter Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Pacificoast Ambulatory Surgicenter LLCCCN 05C0001440

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

Locations

Practitioners 3

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

• Bryan Matthew Brandon

  • Facial Plastic Surgery Physician
  • San Clemente, CA
  • NPI 1548670482
  NPD (past)
• Richard Gangnes, MD

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • San Clemente, CA
  • NPI 1003834318
  NPD (past)
• Tarek I. Hassanein, M.D.

  • Hepatology Physician
  • Coronado, CA
  • NPI 1801854450
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450137600000",
    "number": "1669405684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES",
            "address_2": "SUITE 100C",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES",
            "address_2": "SUITE 100C",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732859",
            "telephone_number": "949-481-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFICOAST AMBULATORY SURGICENTER, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-12-15",
        "status": "A",
        "authorized_official_last_name": "GANGNES",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "949-276-4141"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "18448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC. #",
            "identifier": "18448",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Coast Ambulatory Surgicenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Khrystianne Morita Padua, ATC
• Maria Page, APCC
• Painmd Medical Associates Inc
• Brent R. Palman, P.A.
• Luis Paniagua, DDS

• Ambulatory Surgical Clinic/Center in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; 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.