Surgical Specialists ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGICAL SPECIALISTS ASC, LLC

Practice address

1034 Mar Walt Dr Ste 300
Fort Walton Beach, FL 32547-6645

Phone

(850) 315-9385

Fax

(850) 315-9350

NPI assigned

Sep 27, 2007

Organization subpart

No

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

Authorized official

Name

Chase Deroberto, RN

Title

Admin

Phone

(850) 315-9231

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780871319. Details of each certification follow.

• CCN 100357 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 100357

Legal name

SURGICAL SPECIALISTS ASC LLC

Certification status

Terminated Voluntary: merger or closure, May 11, 2023

Provider type (POS)

Hospital – Short-term

Participating since

Jan 1, 2021

Last certification

Jan 1, 2021

Beds

1

Ownership / control type

Private (for profit)

Facility address

1034 Mar Walt Dr., Unit 300
Fort Walton Beach, FL 32547

Listed as

Surgical Specialists ASC LLCCCN 10C0001515

Medicare certification status

Terminated Voluntary: merger or closure, May 11, 2023From 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 1

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

• Fort Walton Beach Medical Center, Inc.

  dba HCA Florida Fort Walton-Destin Hospital

  • General Acute Care Hospital
  • Fort Walton Beach, FL
  • NPI 1639128820

  Member Of

  NPD member

Practitioners 3

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.

• Jason W Thackeray, M.D.

  • Orthopaedic Surgery Physician
  • Fort Walton Beach, FL
  • NPI 1235133646
  NPD
• James F Watt, DO

  • Orthopaedic Hand Surgery Physician
  • Fort Walton Beach, FL
  • NPI 1700087897
  NPD
• Thomas Jacob Seales, M.D.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Fort Walton Beach, FL
  • NPI 1104184951
  NPD (past)

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781654400000",
    "number": "1780871319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 MAR WALT DR UNIT 300",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476637",
            "telephone_number": "850-315-9385",
            "fax_number": "850-315-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 MAR WALT DR STE 300",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476645",
            "telephone_number": "850-315-9385",
            "fax_number": "850-315-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL SPECIALISTS ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-27",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A",
        "authorized_official_last_name": "DEROBERTO",
        "authorized_official_first_name": "CHASE",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "850-315-9231",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2026; 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.
• 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.