O'Fallon Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

O'FALLON SURGICAL CENTER, LLC

Doing business as

Physicians Surgical Center

Practice address

741 Insight Ave
O Fallon, IL 62269-2193

Phone

(618) 239-0678

Fax

(618) 235-0471

NPI assigned

Mar 15, 2019

Reactivated

May 23, 2019

Last updated

Jul 12, 2021By 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

Shakeel Ahmed, MDNPI 1699792143

Title

Owner

Phone

(618) 239-0678

Specialties & licenses 1

Addresses

Other names 1

• Physicians Surgical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Ofallon Surgical Center LLC Dba Physicians Surgical CenterCCN 14C0001180

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

Locations

Practitioners 1

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.

• Shakeel Ahmed, MD

  • Gastroenterology Physician
  • Fairview Heights, IL
  • NPI 1699792143
  NPD (past) Authorized official

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

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626048000000",
    "number": "1770042111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5023 N ILLINOIS ST",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622083453",
            "telephone_number": "618-239-0678",
            "fax_number": "618-235-0471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 INSIGHT AVE",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692193",
            "telephone_number": "618-239-0678",
            "fax_number": "618-235-0471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "O'FALLON SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-15",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "deactivation_date": "2019-05-20",
        "reactivation_date": "2019-05-23",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "SHAKEEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-239-0678",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Physicians Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Norwood
• Nu-Crown, LLC (Crown Optical)
• Britni Lee Null
• O Fallon Medical Ventures LLC
• O'Fallon Healthcare Center
• O'Fallon Township High School Dist 203
• Oa Associates, LLC
• Oa Associates, LLC
• OB GYN Care LLC
• Anna L Obannonn, RBT

• Ambulatory Surgical Clinic/Center in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; 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.