KS SC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

KS SC LLC

Doing business as

Kelsey Seybold ASC Fort Bend

Practice address

11555 University Blvd
Sugar Land, TX 77478-3889

Phone

(713) 442-5669

NPI assigned

Jan 29, 2024

Last updated

Jan 29, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

KELSEY-SEYBOLD MEDICAL GROUP, PLLCAs reported in NPPES

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

Authorized official

Name

Julie Burch Garcia

Title

Sr Director, Revenue Cycle MGMT

Phone

(713) 442-5027

Specialties & licenses 1

Addresses

Other names 1

• Kelsey Seybold ASC Fort Bend Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720840390. Details of each certification follow.

• CCN 45C0451315 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 45C0451315

Legal name

Kelsey Seybold ASC Fort Bend

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jul 21, 2025

Last certification

Jul 8, 2025

Ownership / control type

Proprietary

Facility address

11555 University Blvd
Sugar Land, TX 77478

Other NPIs with the same Medicare PAC ID 4

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

• KS SC LLC

  dba Kelsey-Seybold ASC Springwoods Village

  • Ambulatory Surgical Clinic/Center
  • Spring, TX
  • NPI 1124894423

  7214351691

  Same PAC ID
• KS SC LLC

  dba Kelsey Seybold ASC Memorial Villages

  • Ambulatory Surgical Clinic/Center
  • Houston, TX
  • NPI 1144977026

  7214351691

  Same PAC ID
• KS SC LLC

  dba Kelsey-Seybold Clinic Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Houston, TX
  • NPI 1699327734

  7214351691

  Same PAC ID
• KS SC LLC

  dba Kelsey Seybold ASC Bay Area

  • Ambulatory Surgical Clinic/Center
  • Webster, TX
  • NPI 1700648037

  7214351691

  Same PAC ID

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

CLIA laboratory certificates

Tax ID family

KS SC LLC5 organizations share this tax ID, including this one

Part of

Kelsey Seybold Medical

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• KS SC LLC

  dba Kelsey-Seybold ASC Springwoods Village

  • Ambulatory Surgical Clinic/Center
  • Spring, TX
  • NPI 1124894423
  NPD tax ID
• KS SC LLC

  dba Kelsey Seybold ASC Memorial Villages

  • Ambulatory Surgical Clinic/Center
  • Houston, TX
  • NPI 1144977026
  NPD tax ID
• KS SC LLC

  dba Kelsey-Seybold Clinic Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Houston, TX
  • NPI 1699327734
  NPD tax ID
• KS SC LLC

  dba Kelsey Seybold ASC Bay Area

  • Ambulatory Surgical Clinic/Center
  • Webster, TX
  • NPI 1700648037
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Kelsey-Seybold Medical Group, PLLC

  dba Kelsey Seybold Clinic

  • Multi-Specialty Clinic/Center
  • Houston, TX
  • NPI 1013915255
  NPPES parent name

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

{
    "created_epoch": "1706486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1720840390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846320",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840001",
            "telephone_number": "713-442-5027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11555 UNIVERSITY BLVD",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774783889",
            "telephone_number": "713-442-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KS SC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KELSEY-SEYBOLD MEDICAL GROUP, PLLC",
        "enumeration_date": "2024-01-29",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "BURCH",
        "authorized_official_title_or_position": "SR DIRECTOR, REVENUE CYCLE MGMT",
        "authorized_official_telephone_number": "713-442-5027"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelsey Seybold ASC Fort Bend",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Sugar Land, TX
• Providers in Sugar Land, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.