Visionary Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

VISIONARY SURGERY CENTER, LLC

Practice address

Visionary Surgery Center, LLC
4335 Edison Lakes Pkwy
Mishawaka, IN 46545

Phone

(417) 447-4484

NPI assigned

Oct 28, 2024

Organization subpart

No

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

Authorized official

Name

Erin Malloy

Title

Administrator

Phone

(417) 447-4484

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 6

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

• Ann K Buikema Wiarda, MD

  • Ophthalmology Physician
  • Warsaw, IN
  • NPI 1538146246
  NPD
• Lindsey Elizabeth Gardner, PA-C

  • Physician Assistant
  • Missoula, MT
  • NPI 1366615098
  NPD (past)
• Kevin M Kolendich, MD

  • Gastroenterology Physician
  • Missoula, MT
  • NPI 1780796888
  NPD (past)
• Thomas Scruggs, CRNA

  • Certified Registered Nurse Anesthetist
  • Missoula, MT
  • NPI 1003847104
  NPD (past)
• Eric Everitt Stone, MD

  • Gastroenterology Physician
  • Missoula, MT
  • NPI 1669511689
  NPD (past)
• Jeff R Willis, M.D.

  • Gastroenterology Physician
  • Missoula, MT
  • NPI 1356385991
  NPD (past)

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

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1821810326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "VISIONARY SURGERY CENTER, LLC",
            "address_2": "4335 EDISON LAKES PKWY",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "46545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "VISIONARY SURGERY CENTER, LLC",
            "address_2": "4335 EDISON LAKES PKWY",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "46545",
            "telephone_number": "417-447-4484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISIONARY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "MALLOY",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "417-447-4484"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Elaina Verteramo, FNP-BC
• Vertical Plus MRI of America, LLC
• Gabriela Vettorello
• Patrick J Viscardi, M.D.
• Vision Value, LLC (Stanton Optical)
• Tanya Christina Vogt, PA-C
• Austin William Vonasek, DPM
• Julie T. Voor, M.A.,CCC-SLP
• Alison C Voreis, RN, MSN, FNP
• Sudhir Bhargav Vyakaranam, MD

• Ambulatory Surgical Clinic/Center in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; 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.