Avon Marketplace ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

AVON MARKETPLACE ASC, LLC

Doing business as

West Indy Surgery Center

Practice address

156 Avon Market PL
Avon, IN 46123-6019

Phone

(317) 983-4103

NPI assigned

Jul 17, 2024

Last updated

Jul 17, 2024By 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

Mr. Schaefer Jon

Title

Chief Executive Officer

Phone

(317) 201-1038

Specialties & licenses 1

Addresses

Other names 1

• West Indy Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750129417. Details of each certification follow.

• CCN 15C0002020 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 15C0002020

Legal name

WEST INDY SURGERY CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jun 6, 2025

Last certification

Jun 6, 2025

Ownership / control type

Proprietary

Facility address

156 Avon Marketplace
Avon, IN 46123

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

CLIA laboratory certificates

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

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1750129417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 308",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460770308",
            "telephone_number": "317-983-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 AVON MARKET PL",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461236019",
            "telephone_number": "317-983-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVON MARKETPLACE ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "JON",
        "authorized_official_first_name": "SCHAEFER",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "317-201-1038",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Indy Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Avon, IN
• Providers in Avon, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.