NPIMap

Organization Active NPI

Gateway Ambulatory Surgery Center, LLC

  • Clinic/Center
  • Concord, NC
National Provider Identifier
1689761546
Registry record updated Jun 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
AS0070 Issued in NC
Legal business name
GATEWAY AMBULATORY SURGERY CENTER, LLC
Practice address
1025 Northeast Gateway Court, NE
Concord, NC 28025
Phone
(704) 920-7020
Fax
(704) 920-7063
NPI assigned
Oct 10, 2006
Last updated
Jun 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2015

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

Authorized official

Name
Robert Bashore
Title
Administrator
Phone
(704) 920-7027

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X AS0070 NC Primary
Ambulatory Surgical Clinic/Center 261QA1903X 060202 NC

Addresses

Primary practice location

1025 Northeast Gateway Court, NE
Concord, NC 28025

Mailing address

1025 Northeast Gateway Court, NE
Concord, NC 28025
Phone (704) 920-7020

Other identifiers 1

IdentifierTypeStateIssuer
3409938MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060405000135 NC Part B Supplier - Ambulatory Surgical Center 7618985441 Practice locations: Concord, NC

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Gateway Ambulatory Surgery CenterCCN 34C0001113
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 1

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1025 NE Gateway Ct NE
Concord, NC 28025
Phone (704) 920-7020

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433808000000",
    "number": "1689761546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 NORTHEAST GATEWAY COURT, NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "28025",
            "telephone_number": "704-920-7020",
            "fax_number": "704-920-7063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 NORTHEAST GATEWAY COURT, NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "28025",
            "telephone_number": "704-920-7020",
            "fax_number": "704-920-7063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2015-06-09",
        "status": "A",
        "authorized_official_last_name": "BASHORE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-920-7027"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NC",
            "license": "AS0070",
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": "060202",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409938",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.