NPIMap

Organization Active NPI

Eye Surgery Center of Saint Augustine Inc

  • Ambulatory Surgical Clinic/Center
  • St Augustine, FL
National Provider Identifier
1750383295
Registry record updated Jan 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
F1416 Issued in FL
Legal business name
EYE SURGERY CENTER OF SAINT AUGUSTINE INC
Practice address
1400 US Highway 1 S
St Augustine, FL 32084-4211
Phone
(904) 829-2344
NPI assigned
Aug 15, 2005
Last updated
Jan 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2013

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

Authorized official

Name
Paul W Hund III, M.D.NPI 1750382487
Title
Medical Director
Phone
(904) 829-2344

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 F1416 FL Primary

Addresses

Primary practice location

1400 US Highway 1 S
St Augustine, FL 32084-4211

Mailing address

1400 US Highway 1 S
St Augustine, FL 32084-4211
Phone (904) 829-2344

Other identifiers 4

IdentifierTypeStateIssuer
AHCA ID NUMBEROtherFL14960504
LICENSE NUMBEROtherFL1195
BLUE CROSS BLUE SHIEOtherFL6G6
075723300MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040406000186 FL Part B Supplier - Ambulatory Surgical Center 4183617236 Practice locations: St Augustine, FL

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Eye Surgery Center of Saint Augustine IncCCN 10C0001416
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1400 US Highway 1 S
Ste B
Saint Augustine, FL 32084
Phone (904) 829-2286

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": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358380800000",
    "number": "1750383295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 US HIGHWAY 1 S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320844211",
            "telephone_number": "904-829-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 US HIGHWAY 1 S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320844211",
            "telephone_number": "904-829-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SURGERY CENTER OF SAINT AUGUSTINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2013-01-17",
        "status": "A",
        "authorized_official_last_name": "HUND",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "904-829-2344",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "F1416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "14960504",
            "identifier": "AHCA ID NUMBER",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1195",
            "identifier": "LICENSE NUMBER",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "6G6",
            "identifier": "BLUE CROSS BLUE SHIE",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075723300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; 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.