NPIMap

Organization Active NPI

Surgery Center at Gateway LLC

Doing business as Surgery Center At Gateway

  • Anesthesiology Physician
  • Flint, MI
National Provider Identifier
1679270144
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SURGERY CENTER AT GATEWAY LLC
Doing business as
Surgery Center At Gateway
Practice address
5302 Gateway Ctr
Flint, MI 48507-3930
Phone
(810) 285-9901
Fax
(810) 285-9974
NPI assigned
Feb 14, 2023
Last updated
Dec 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Authorized official

Name
Edward P Stack, MDNPI 1801899885
Title
Owner
Phone
(810) 720-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

5302 Gateway Ctr
Flint, MI 48507-3930

Mailing address

PO Box 713477
Chicago, IL 60677-4377
Phone (810) 285-9901

Other names 1

  • Surgery Center At Gateway Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190731003850 MI Part B Supplier - Ambulatory Surgical Center 9133455918 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Flint, MI
O20230503002029 MI Part B Supplier - Clinic/Group Practice 9133455918 Receives reassigned benefits from 6 practitioners
Practice locations: Flint, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
SCG Anesthesia PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1679270144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713477",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606774377",
            "telephone_number": "810-285-9901",
            "fax_number": "810-285-9974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5302 GATEWAY CTR",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485073930",
            "telephone_number": "810-285-9901",
            "fax_number": "810-285-9974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER AT GATEWAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-14",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "STACK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-720-9111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgery Center At Gateway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.