NPIMap

Organization Active NPI

Mankato Surgical Center, L.L.C.

Doing business as Mankato Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Mankato, MN
National Provider Identifier
1720161615
Registry record updated Mar 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
331023 Issued in MN
Legal business name
MANKATO SURGICAL CENTER, L.L.C.
Doing business as
Mankato Surgery Center
Practice address
1411 Premiere Dr
Mankato, MN 56001
Phone
(507) 388-6000
Fax
(507) 388-6913
NPI assigned
Oct 23, 2006
Last updated
Mar 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2022

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

Authorized official

Name
Sara L Ebert
Title
Controller/Business Office Manager
Phone
(507) 388-6000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Ambulatory Surgical Clinic/Center 261QA1903X 331023 MN Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

1411 Premiere Dr
Mankato, MN 56001

Mailing address

1411 Premiere Dr
Mankato, MN 56001-6076
Phone (507) 388-6000

Other names 1

  • Mankato Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100121000534 MN Part B Supplier - Ambulatory Surgical Center 2163564659 Receives reassigned benefits from 25 practitioners
Practice locations: Mankato, MN

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Mankato Surgery CenterCCN 24C0001036
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 2

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

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647561600000",
    "number": "1720161615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 PREMIERE DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016076",
            "telephone_number": "507-388-6000",
            "fax_number": "507-388-6913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 PREMIERE DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-388-6000",
            "fax_number": "507-388-6913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANKATO SURGICAL CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A",
        "authorized_official_last_name": "EBERT",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CONTROLLER/BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "507-388-6000"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MN",
            "license": "331023",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mankato Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mankato Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; 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.