Riverside Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

7003049 Issued in IL

Legal business name

RIVERSIDE AMBULATORY SURGERY CENTER, LLC

Practice address

300 Riverside Dr Ste 1100
Bourbonnais, IL 60914-4997

Phone

(815) 802-3170

NPI assigned

Aug 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Teresa Bockover, RN

Title

Clinical Director

Phone

(815) 802-3170

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Riverside Ambulatory Surgery Center LLCCCN 14C0001120

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 1

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

• Riverside Medical Center

  • Psychiatric Hospital Unit
  • Kankakee, IL
  • NPI 1982093837

  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, and the practitioner matching its NPPES authorized official.

• Rebecca J Hodulik, DPM

  • Foot & Ankle Surgery Podiatrist
  • Manteno, IL
  • NPI 1609853746
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851407373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RIVERSIDE DR STE 1100",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RIVERSIDE DR STE 1100",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144997",
            "telephone_number": "815-802-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOCKOVER",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "815-802-3170",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7003049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Retina of Illinois, S.C.
• Revere Dental
• Richard F. Callahan, LTD.
• Kelly Richter
• Sara Lynn Riegel-Kesner, DC
• Riverside Health System
• Riverside Medical Center
• Riverside Medical Center
• Riverview Pharmacies Inc (Riverview Pharmacy)
• Riverview Pharmacies Inc (Riverview Pharmacy LTC/Riverview Pharmacy Inc)

• Ambulatory Surgical Clinic/Center in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.