Stadium Campus Ambulatory Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

11381500 Issued in PA

Legal business name

STADIUM CAMPUS AMBULATORY SURGICAL CENTER, LLC

Doing business as

Wills Eye Surgery Center

Practice address

3340 S Broad St
Philadelphia, PA 19145-5802

Phone

(215) 463-1900

NPI assigned

Oct 26, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Joseph Bilson

Title

President

Phone

(215) 440-3152

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wills Eye Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Listed as

Wills Surgical Center Stadium CampusCCN 39C0001085

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 5

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

• Brad H Feldman, MD

  • Ophthalmology Physician
  • Philadelphia, PA
  • NPI 1750554507
  NPD (past)
• Kenneth C Heist, D.O.

  • Ophthalmology Physician
  • Philadelphia, PA
  • NPI 1730269481
  NPD (past)
• Vincent Basan Lam, M.D.

  • Ophthalmology Physician
  • Philadelphia, PA
  • NPI 1477713576
  NPD (past)
• Jon Peet, MD

  • Ophthalmology Physician
  • Levittown, PA
  • NPI 1538323175
  NPD (past)
• Carolyn S Repke, MD

  • Ophthalmology Physician
  • Philadelphia, PA
  • NPI 1093716532
  NPD (past)

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679658710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191455802",
            "telephone_number": "215-463-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191455802",
            "telephone_number": "215-463-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STADIUM CAMPUS AMBULATORY SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BILSON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-440-3152",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "11381500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017912500002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wills Eye Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine Isabel Stackhouse, CRNP
• Wayne Anthony Stackhouse
• Caroline Stacks
• Anna Stacy, MD
• Arthur Petrie Staddon, MD
• Edward A Stadtmauer, MD
• Elizabeth Staebler
• Carol A Staffieri, CRNA
• Staffmore
• Brenda Arlene Stafford, MHS

• Ambulatory Surgical Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.