Derry Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

DERRY SURGICAL CENTER, LLC

Practice address

15 Tsienneto Road
Derry, NH 03038

Phone

(833) 946-0896

Fax

(603) 371-2680

NPI assigned

Oct 7, 2019

Organization subpart

No

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

Authorized official

Name

Gina Mondo

Title

Manager

Phone

(833) 946-0896

Specialties & licenses 1

Addresses

Other names 1

• Surgical Center of New Hampshire at Derry Doing business as

Medicare fee-for-service enrollment

Enrolled in NH

Enrollment records 1

Listed as

Derry Surgical Center Dba Surgical Center of New Hampshire at DerryCCN 30C0001047

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Granite State Gastrointestinal Consultants PLLC

  • Gastroenterology Physician
  • Londonderry, NH
  • NPI 1942214457

  Member Of

  NPD member
• New England Molecular Imaging LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Raymond, NH
  • NPI 1619645561

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1750922142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 TSIENNETO ROAD",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "03038",
            "telephone_number": "833-946-0896",
            "fax_number": "603-371-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 TSIENNETO ROAD",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "03038",
            "telephone_number": "833-946-0896",
            "fax_number": "603-371-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRY SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-07",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "MONDO",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "833-946-0896"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgical Center of New Hampshire at Derry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Derry Neurological Associates, PC
• Derry Pediatrics
• Derry Rehabilitation and Nursing Center LLC
• Derry Sports & Rehab, LLC
• Derry Surgery Center LP
• Karen M Desmarais, LCMHC
• Kate Lynn Desmond, BCBA
• Diabetes and Lifestyle Management, LLC
• Maria Michelle Diaz, M.D.
• Andrew Dibartolo, DPT

• All providers in Derry, NH
• Ambulatory Surgical Clinic/Center in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.