NPIMap

Organization Active NPI

Turtle Creek Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Tyler, TX
National Provider Identifier
1699819979
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
008054 Issued in TX
Legal business name
TURTLE CREEK SURGERY CENTER LLC
Practice address
805 Turtle Creek Dr
Tyler, TX 75701-1937
Phone
(903) 592-1664
Fax
(903) 592-6595
NPI assigned
Feb 19, 2007
Last updated
Oct 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Authorized official

Name
Dr. Makoto Saigusa, DMD, MDNPI 1417067497
Title
Owner
Phone
(903) 592-1664

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 008054 TX Primary

Addresses

Primary practice location

805 Turtle Creek Dr
Tyler, TX 75701-1937

Mailing address

801 Turtle Creek Dr
Tyler, TX 75701-1937
Phone (903) 592-1664

Other identifiers 1

IdentifierTypeStateIssuer
167240401MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040908001047 TX Part B Supplier - Ambulatory Surgical Center 7416923735 Practice locations: Tyler, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Turtle Creek Surgery Center LLCCCN 45C0001356
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

805 Turtle Creek Dr
Tyler, TX 75701
Phone (903) 592-1664

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727913600000",
    "number": "1699819979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 TURTLE CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011937",
            "telephone_number": "903-592-1664",
            "fax_number": "903-592-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 TURTLE CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011937",
            "telephone_number": "903-592-1664",
            "fax_number": "903-592-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TURTLE CREEK SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A",
        "authorized_official_last_name": "SAIGUSA",
        "authorized_official_first_name": "MAKOTO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-592-1664",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "008054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167240401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; 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.