Eye MD of Niceville Surgery LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EYE MD OF NICEVILLE SURGERY LLC

Practice address

1480 Hickory St Ste 106
Niceville, FL 32578-8843

Phone

(850) 760-0520

Fax

(850) 760-0501

NPI assigned

Feb 22, 2021

Last updated

Feb 22, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

EYE M.D. OF NICEVILLE LLCAs reported in NPPES

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

Authorized official

Name

Maria Ruttig

Title

Practice Administrator

Phone

(703) 489-8720

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841884731. Details of each certification follow.

• CCN 10C0001731 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 10C0001731

Legal name

EYE MD OF NICEVILLE SURGERY

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Nov 20, 2023

Last certification

Nov 20, 2023

Ownership / control type

Proprietary

Facility address

1480 Hickory Street
Niceville, FL 32578

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Eye MD of Niceville LLC

Locations

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.

• Eye M.D. of Niceville LLC

  • Ophthalmology Physician
  • Niceville, FL
  • NPI 1962875823
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nathaniel Jacob Ruttig, M.D.

  • Ophthalmology Physician
  • Niceville, FL
  • NPI 1295710127
  NPD

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

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1841884731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1480 HICKORY ST STE 106",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 HICKORY ST STE 106",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788843",
            "telephone_number": "850-760-0520",
            "fax_number": "850-760-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE MD OF NICEVILLE SURGERY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EYE M.D. OF NICEVILLE LLC",
        "enumeration_date": "2021-02-22",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "RUTTIG",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "703-489-8720"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Lynn Etheridge, PT
• Ginny Rebecca Everton, PMHNP-BC
• Ewing Family Chiropractic (Russell Chiropractic)
• Scott E Ewing, DC
• Eye M.D. of Niceville LLC
• F Duncan Scott MD PA
• F&H Inc
• Deana D Fagundes, M.S. CCC-SLP
• Sheryl Fain, CRNP
• Stephanie L Faist, RN

• Ambulatory Surgical Clinic/Center in Niceville, FL
• Providers in Niceville, 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 Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.