NPIMap

Organization Active NPI

Specialty Surgical Center, LLC

  • Anesthesiology Physician
  • Sparta, NJ
National Provider Identifier
1821398199
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SPECIALTY SURGICAL CENTER, LLC
Practice address
380 Lafayette Rd
Suite 110
Sparta, NJ 07871-3556
Phone
(973) 940-3166
Fax
(973) 940-3170
NPI assigned
Nov 2, 2010
Organization subpart
Yes
Parent organization
SPECIALTY SURGICAL CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

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

Authorized official

Name
Donald Mykulik, MD
Title
Administrator
Phone
(973) 940-3166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

380 Lafayette Rd
Suite 110
Sparta, NJ 07871-3556

Mailing address

PO Box 95000-4525
Philadelphia, PA 19195-4525
Phone (717) 263-5562

Other names 1

  • Specialty Surgical Center Anesthesia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110222000734 NJ Part B Supplier - Clinic/Group Practice 0941384655 Receives reassigned benefits from 11 practitioners
Practice locations: Sparta, NJ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Specialty Surgical Center LLC2 organizations share this tax ID, including this one
Part of
Specialty Surgical Center LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

380 Lafayette Rd
Ste 110
Sparta, NJ 07871
Phone (973) 940-3166

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288656000000",
    "number": "1821398199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95000-4525",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191954525",
            "telephone_number": "717-263-5562",
            "fax_number": "717-263-1566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 LAFAYETTE RD",
            "address_2": "SUITE 110",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078713556",
            "telephone_number": "973-940-3166",
            "fax_number": "973-940-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY SURGICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECIALTY SURGICAL CENTER, LLC",
        "enumeration_date": "2010-11-02",
        "last_updated": "2010-11-02",
        "status": "A",
        "authorized_official_last_name": "MYKULIK",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "973-940-3166",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Specialty Surgical Center Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sparta, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.