NPIMap

Organization Active NPI

Novamed Surgery Center of Colorado Springs, LLC

Doing business as Premier Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Colorado Springs, CO
National Provider Identifier
1750386322
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
0239 Issued in CO
Legal business name
NOVAMED SURGERY CENTER OF COLORADO SPRINGS, LLC
Doing business as
Premier Surgery Center
Practice address
3920 N Union Blvd Ste 240
Colorado Springs, CO 80907-4920
Phone
(719) 227-9711
Fax
(719) 227-9725
NPI assigned
Jun 20, 2005
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Authorized official

Name
Jennifer B. Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5954

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 0239 CO Primary

Addresses

Primary practice location

3920 N Union Blvd Ste 240
Colorado Springs, CO 80907-4920

Mailing address

3920 N Union Blvd Ste 240
Colorado Springs, CO 80907-4920
Phone (719) 227-9711

Other identifiers 2

IdentifierTypeStateIssuer
75600331MedicaidCO
490005417OtherRR MEDICARE

Other names 1

  • Premier Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317001341 CO Part B Supplier - Ambulatory Surgical Center 5294625810 Practice locations: Colorado Springs, CO

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Novamed Eye Surgery Center of Colorado Springs Dba Premier Surgery CenterCCN 06C0001051
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Novamed Surgery Center of Colorado Springs LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1189 Reliable Pkwy
Chicago, IL 60686

Practitioners & affiliated clinicians

Practitioners 74

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 74

NPI Registry JSON

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1750386322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 N UNION BLVD STE 240",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809074920",
            "telephone_number": "719-227-9711",
            "fax_number": "847-296-5990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 N UNION BLVD STE 240",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809074920",
            "telephone_number": "719-227-9711",
            "fax_number": "719-227-9725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVAMED SURGERY CENTER OF COLORADO SPRINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CO",
            "license": "0239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "75600331",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "490005417",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; 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.