Watsonville Surgeons Group LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

070000651 Issued in CA

Legal business name

WATSONVILLE SURGEONS GROUP LLC

Practice address

160 Green Valley Rd
Suite 101
Freedom, CA 95019-3160

Phone

(831) 763-9700

Fax

(831) 763-9799

NPI assigned

Jul 29, 2006

Organization subpart

No

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

Authorized official

Name

Patrick Seubert Haley

Title

Treasurer

Phone

(831) 462-5512

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Central Coast Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Watsonville Surgeons GroupCCN 05C0001580

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 1

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

• Monterey Bay Heart Center

  • Specialist
  • Santa Cruz, CA
  • NPI 1720100480

  Member Of

  NPD member

Practitioners 1

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

• Mark Andrew Rosen, M.D.

  • Urology Physician
  • Santa Cruz, CA
  • NPI 1134213754
  NPD (past)

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557964800000",
    "number": "1790799047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 GREEN VALLEY RD",
            "address_2": "SUITE 101",
            "city": "FREEDOM",
            "state": "CA",
            "postal_code": "950193160",
            "telephone_number": "831-763-9700",
            "fax_number": "831-763-9799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 GREEN VALLEY RD",
            "address_2": "SUITE 101",
            "city": "FREEDOM",
            "state": "CA",
            "postal_code": "950193160",
            "telephone_number": "831-763-9700",
            "fax_number": "831-763-9799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATSONVILLE SURGEONS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2019-05-16",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "SEUBERT",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "831-462-5512"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "070000651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR01580F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Coast Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central Coast Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeric Canda Villaruz, MD
• Trang T Vu, PHARM D
• Walgreen Co
• Sarah Elaine Walker, DDS
• Ronald I Waloff, MD
• Nayeli Zamora

• All providers in Freedom, CA
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; 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.