Antelope Valley Specialty Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ANTELOPE VALLEY SPECIALTY SURGICAL CENTER, LLC

Practice address

655 W Avenue Q
Palmdale, CA 93551-3894

Phone

(818) 348-7246

Fax

(818) 348-7248

NPI assigned

Jul 31, 2017

Last updated

Jul 31, 2017By 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

Rebecca Riedel, RN

Title

Director of Nursing

Phone

(818) 348-7251

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780108951. Details of each certification follow.

• CCN 05C0002225 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 05C0002225

Legal name

ANTELOPE VALLEY SPECIALTY SURGICAL CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Mar 22, 2019

Last certification

Mar 22, 2019

Ownership / control type

Proprietary

Facility address

655 West Avenue Q, Suite B
Palmdale, CA 93551

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.

• Paul Bennett Johnson, M.D.

  • Interventional Pain Medicine Physician
  • West Hills, CA
  • NPI 1750449229
  NPD (past)

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

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501459200000",
    "number": "1780108951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7230 MEDICAL CENTER DR STE 500",
            "city": "WEST HILLS",
            "state": "CA",
            "postal_code": "913074024",
            "telephone_number": "818-348-7246",
            "fax_number": "818-348-7248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W AVENUE Q",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935513894",
            "telephone_number": "818-348-7246",
            "fax_number": "818-348-7248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY SPECIALTY SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-31",
        "last_updated": "2017-07-31",
        "status": "A",
        "authorized_official_last_name": "RIEDEL",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "818-348-7251",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antelope Valley Hospital OB Clinic Palmdale
• Antelope Valley Impotence & Incontinence Medical Center, Inc
• Antelope Valley Lung & Sleep Institute, Inc
• Antelope Valley Outpatient Imaging Center, LLC
• Antelope Valley Outpatient Imaging Center, LLC
• Antelope Valley Summit Medical Group, Inc (Summit Urgent Care)
• Antelope Valley Surgery Center, PC
• Antelope Valley Women's Healthcare, Inc
• Diana Jeannette Anzora
• Guadalupe Apolinar

• Ambulatory Surgical Clinic/Center in Palmdale, CA
• Providers in Palmdale, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.