Broadwest Specialty Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BROADWEST SPECIALTY SURGICAL CENTER, LLC

Practice address

315 W 89TH Avenue
Merrillville, IN 46410-6254

Phone

(219) 757-5275

Fax

(219) 757-5292

NPI assigned

May 10, 2006

Organization subpart

No

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

Authorized official

Name

Vijay K. Gupta, M.D.NPI 1740289313

Title

President/Ceo

Phone

(219) 757-5275

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

Broadwest Specialty Surgical Center LLCCCN 15C0001151

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vijay Gupta, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Munster, IN
  • NPI 1740289313
  NPD Authorized official
• Stephen Keith Grandfield, DPM

  • Foot & Ankle Surgery Podiatrist
  • Merrillville, IN
  • NPI 1811008204
  NPD
• David Francis Ray, DPM

  • Foot & Ankle Surgery Podiatrist
  • Schererville, IN
  • NPI 1932119989
  NPD (past)

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1770532194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W 89TH AVENUE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106254",
            "telephone_number": "219-757-5275",
            "fax_number": "219-757-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W 89TH AVENUE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106254",
            "telephone_number": "219-757-5275",
            "fax_number": "219-757-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWEST SPECIALTY SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "VIJAY",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "219-757-5275",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bristol Hospice - Indiana LLC
• Briyot Healthcare PC
• Broadway Dentistry, PC
• Broadway Neck and Back, Inc
• Broadway Plaza Pain Relief Center
• Sanjuana Broden, PTA
• Genna Rose Brook, BSW, RBT
• Garcsa Brooks, LPC
• Rahshonda Brooks, MA
• Shasha Letrice Brooks, MEDICAL ASSISTANT

• Ambulatory Surgical Clinic/Center in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; 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.