Alta-Rose Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

3981ASC-3 Issued in NV

Legal business name

ALTA-ROSE SURGERY CENTER LLC

Practice address

501 Rose St
Suite 110
Las Vegas, NV 89106-4053

Phone

(702) 386-9906

Fax

(702) 386-9910

NPI assigned

Mar 21, 2006

Organization subpart

No

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

Authorized official

Name

Douglas K Devries, MD

Title

Owner

Phone

(775) 674-1100

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Listed as

Alta Rose Surgery CenterCCN 29C0001058

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

Practitioners 1

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

• Stewart Dongin Park, M.D.

  • Ophthalmology Physician
  • Las Vegas, NV
  • NPI 1457365215

  NV

  Medicare reassignment NPD

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701129600000",
    "number": "1841259611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 ROSE ST",
            "address_2": "SUITE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064053",
            "telephone_number": "702-386-9906",
            "fax_number": "702-386-9910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 ROSE ST",
            "address_2": "SUITE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064053",
            "telephone_number": "702-386-9906",
            "fax_number": "702-386-9910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA-ROSE SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A",
        "authorized_official_last_name": "DEVRIES",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-674-1100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NV",
            "license": "3981ASC-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100505697",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Alta Oral Surgery, LLC
• Alta Wellness Center LLC
• Joelita Altabet
• Angelina Marie Altaf
• Jose Elias Altamirano Zeledon, MD
• Destiny Marie Altamirano-de-Ramos
• Claudia Altamirano

• All providers in Las Vegas, NV
• Ambulatory Surgical Clinic/Center in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; 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.