Southpark Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

AS0032 Issued in NC

Legal business name

SOUTHPARK SURGERY CENTER LLC

Practice address

6035 Fairview Rd
Ste 300
Charlotte, NC 28210-3256

Phone

(704) 295-3000

NPI assigned

May 18, 2006

Organization subpart

No

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

Authorized official

Name

Fred M Hargett

Title

Evp Cfo

Phone

(704) 384-5184

Specialties & licenses 1

Addresses

Other names 1

• SouthPark Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Listed as

Novant Health Southpark Surgery CenterCCN 34C0001112

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

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

• The Presbyterian Hospital

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1376870832

  Member Of

  NPD member

Locations

Practitioners 1

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

• Tiffany Brooke Bratina, CRNA

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
  • NPI 1447495890
  Medicare reassignment NPD

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288051200000",
    "number": "1811940141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 FRONTIS PLAZA BLVD",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271035614",
            "telephone_number": "336-277-7226",
            "fax_number": "336-277-9795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6035 FAIRVIEW RD",
            "address_2": "STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103256",
            "telephone_number": "704-295-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPARK SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2010-10-26",
        "status": "A",
        "authorized_official_last_name": "HARGETT",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EVP CFO",
        "authorized_official_telephone_number": "704-384-5184"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": "AS0032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SouthPark Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southpark Counseling PLLC
• Southpark Functional Medicine PLLC
• Southpark Pediatrics, P.a.
• Southpark Psychotherapy PLLC
• Southpark Senior Living LLC
• Southside Counseling Center, LLC
• Southview Dentistry
• Anna Southwick, LCMHCS
• Paige Southwick
• Kayla M Sova

• Ambulatory Surgical Clinic/Center in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Ambulatory Surgical Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; 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.