NPIMap

Organization Active NPI

Premier Ambulatory Surgery of Austin LLP

Doing business as South Austin Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Austin, TX
National Provider Identifier
1821174780
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
000262 Issued in TX
Legal business name
PREMIER AMBULATORY SURGERY OF AUSTIN LLP
Doing business as
South Austin Surgery Center
Practice address
4207 James Casey St
Suite 203
Austin, TX 78745-1192
Phone
(512) 440-7894
Fax
(512) 440-1932
NPI assigned
Oct 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

Name
Phillip A. Clendenin
Title
President
Phone
(615) 665-1823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 000262 TX Primary

Addresses

Primary practice location

4207 James Casey St
Suite 203
Austin, TX 78745-1192

Mailing address

4207 James Casey St
Suite 203
Austin, TX 78745-1192
Phone (512) 440-7894

Other identifiers 2

IdentifierTypeStateIssuer
HH1236OtherTXBCBS
092974702MedicaidTX

Other names 1

  • South Austin Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 45C0001031

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SOUTH AUSTIN SURGERY CENTER LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Apr 30, 1985
Last certification
Jan 9, 2018
Ownership / control type
Proprietary
Facility address
4207 James Casey Suite 203
Austin, TX 78745

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1821174780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4207 JAMES CASEY ST",
            "address_2": "SUITE 203",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787451192",
            "telephone_number": "512-440-7894",
            "fax_number": "512-440-1932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4207 JAMES CASEY ST",
            "address_2": "SUITE 203",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787451192",
            "telephone_number": "512-440-7894",
            "fax_number": "512-440-1932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER AMBULATORY SURGERY OF AUSTIN LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "CLENDENIN",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1823"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "000262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "HH1236",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092974702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Austin Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.