Avon Marketplace ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

AVON MARKETPLACE ASC, LLC

Practice address

156 Avon Market PL
Avon, IN 46123-6019

Phone

(317) 983-4103

NPI assigned

Jul 17, 2024

Organization subpart

No

Name

Mr. Schaefer Jon

Title

Chief Executive Officer

Phone

(317) 201-1038

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

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

• West Indy Surgery Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 17, 2024.

{
    "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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• All providers in Avon, IN
• 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.
• 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.