Fallsgrove Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

A1435 Issued in MD

Legal business name

FALLSGROVE SURGERY CENTER

Practice address

14955 Shady Grove Rd
Suite 125
Rockville, MD 20850-8700

Phone

(301) 340-1495

Fax

(301) 838-9712

NPI assigned

Sep 24, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Siu Ting NG-Wagner, M.D.NPI 1851491476

Title

Medical Director

Phone

(301) 340-1495

Specialties & licenses 1

Addresses

Other names 1

• Fallsgrove Surgery Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 21C0001435

Legal name

FALLSGROVE SURGERY CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Apr 14, 2006

Last certification

Mar 16, 2021

Ownership / control type

Proprietary

Facility address

14955 Shady Grove Road, #125
Rockville, MD 20850

Practitioners 2

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

• Siu Ting NG-Wagner, M.D.

  • Reproductive Endocrinology Physician
  • Rockville, MD
  • NPI 1851491476
  NPD Authorized official
• David Gordon Wagner, MD

  • Ophthalmology Physician
  • Rockville, MD
  • NPI 1326046897
  NPD (past)

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1679673297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14955 SHADY GROVE RD",
            "address_2": "SUITE 125",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208508700",
            "telephone_number": "301-340-1495",
            "fax_number": "301-838-9712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14955 SHADY GROVE RD",
            "address_2": "SUITE 125",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208508700",
            "telephone_number": "301-340-1495",
            "fax_number": "301-838-9712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLSGROVE SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-24",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "NG-WAGNER",
        "authorized_official_first_name": "SIU TING",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-340-1495",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fallsgrove Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fallsgrove Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allan L Falk, D.D.S.
• Siah Fallah
• Karina Fallejo
• Judith C Fallon, M.D.
• Fallsgrove Endoscopy Center, LLC
• Titilayo Famakinwa
• Family Center for Allergy and Asthma LLC
• Family Dental Care PC
• Family ENT Allergy and Asthma Center PC
• Family First, Inc

• Ambulatory Surgical Clinic/Center in Rockville, MD
• Providers in Rockville, MD by specialty
• Ambulatory Surgical Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.