Park Avenue Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0769 Issued in CO

Legal business name

PARK AVENUE SURGERY CENTER LLC

Practice address

1800 Emerson St
Ste 200
Denver, CO 80218

Phone

(303) 468-8844

Fax

(303) 468-8850

NPI assigned

Nov 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jerry K Popham, MDNPI 1588661920

Title

President

Phone

(303) 468-8844

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Listed as

Park Avenue Surgery Center LLCCCN 06C0001088

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Park Avenue Surgery Center2 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.

• Park Avenue Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Denver, CO
  • NPI 1154328508
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Jerry K Popham, MD PC

  dba Park Avenue OculoPlastic Surgeons

  • Specialist
  • Denver, CO
  • NPI 1225162134

  Member Of

  NPD member

Practitioners 3

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

• Jerry Kirk Popham, M.D.

  • Ophthalmology Physician
  • Denver, CO
  • NPI 1588661920
  Medicare reassignment NPD Authorized official
• Christopher K Thiagarajah, MD

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Edwards, CO
  • NPI 1952435919
  Medicare reassignment NPD
• Samuel Yan-Ho Chan, M.D.

  • Specialist
  • Denver, CO
  • NPI 1508830811
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1689748758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 EMERSON ST",
            "address_2": "STE 200",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80218",
            "telephone_number": "303-468-8844",
            "fax_number": "303-468-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 EMERSON ST",
            "address_2": "STE 200",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80218",
            "telephone_number": "303-468-8844",
            "fax_number": "303-468-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "POPHAM",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-468-8844",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CO",
            "license": "0769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "88530221",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Eugene Parham, D.C.
• Masey Paris
• Michael S Pariset, DO
• Chiara Parisi
• Park Avenue Surgery Center LLC
• Ashley Park
• Ashley Park, MA, LPCC, ATR-P
• Eun Chil Park, M.D.
• Hwajin Park
• Jung Min Park, LIC. AC.

• Ambulatory Surgical Clinic/Center in Denver, CO
• Providers in Denver, CO by specialty
• Ambulatory Surgical Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; 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.