Surgcenter of Orange Park, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGCENTER OF ORANGE PARK, LLC

Practice address

805 Wells Rd FL 1
Orange Park, FL 32073-2301

Phone

(904) 643-3326

Fax

(904) 592-9726

NPI assigned

Oct 29, 2012

Organization subpart

No

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

Authorized official

Name

Collin Lemaistre

Title

Officer/Authorized Official

Phone

(214) 213-0723

Specialties & licenses 1

Addresses

Other names 1

• Orange Park Endoscopy Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Surgcenter of Orange Park LLCCCN 10C0001579

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 2

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

• Baylor University Medical Center

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1447250253

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  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.

• Jorg A Bober, DPM

  • Foot & Ankle Surgery Podiatrist
  • Orange Park, FL
  • NPI 1720108012
  NPD (past)

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

{
    "created_epoch": "1351468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1821342858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 WELLS RD FL 1",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732301",
            "telephone_number": "904-643-3326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 WELLS RD FL 1",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732301",
            "telephone_number": "904-643-3326",
            "fax_number": "904-592-9726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGCENTER OF ORANGE PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-29",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "LEMAISTRE",
        "authorized_official_first_name": "COLLIN",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "214-213-0723"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Orange Park Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Summit Physical Therapy, PLLC
• Summit Physical Therapy, PLLC
• Sunshine State Anesthesia Partners LLC
• Sunshine Vital Transport LLC
• Jaerine Roa Superales
• Gerry Surrency, PMHNP-BC, ARNP
• Susan I Murray PA
• Susan Salehi MD PA
• Lyudmyla Susla
• Melissa Marie Sutton, PA-C

• Ambulatory Surgical Clinic/Center in Orange Park, FL
• Providers in Orange Park, 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 Sep 13, 2024; 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.