BSM Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BSM SURGERY CENTER LLC

Practice address

1128 NE Second Street
Suite 104
Corvallis, OR 97330-6293

Phone

(541) 207-3334

Fax

(541) 207-3231

NPI assigned

Jun 4, 2009

Last updated

Sep 18, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Dawn Kolb

Title

Manager

Phone

(541) 268-4641

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Listed as

BSM Surgery Center LLCCCN 38C0001096

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Ronald D Wobig, MD

  • Orthopaedic Surgery Physician
  • Corvallis, OR
  • NPI 1306834601
  NPD
• John G Dodd, DO

  • Ophthalmology Physician
  • Salem, OR
  • NPI 1215190400
  NPD (past)
• Gregory Allen Richard, MD

  • Ophthalmology Physician
  • Corvallis, OR
  • NPI 1295013613
  NPD (past)

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

{
    "created_epoch": "1244073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442534400000",
    "number": "1689800666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1128 NE SECOND STREET",
            "address_2": "SUITE 104",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306293",
            "telephone_number": "541-207-3334",
            "fax_number": "541-207-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 NE SECOND STREET",
            "address_2": "SUITE 104",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306293",
            "telephone_number": "541-207-3334",
            "fax_number": "541-207-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BSM SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-04",
        "last_updated": "2015-09-18",
        "status": "A",
        "authorized_official_last_name": "KOLB",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "541-268-4641"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500639211",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Bryan, RPH
• Pete Bryant, STUDENT
• Zach Bryant
• Noah Tyler Bryce
• Gage Aaron Bryers
• Benjamin Buchalski
• Paula Buck, CRM, HCW, CADC-R
• Kara Diane Rae Budd
• Christopher Anthony Bueford
• Ellen Buford

• Ambulatory Surgical Clinic/Center in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.