NPIMap

Organization Active NPI

Northern Lakes Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Hayden, ID
National Provider Identifier
1861271629
Registry record updated Jul 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
NORTHERN LAKES SURGERY CENTER, LLC
Practice address
8552 N Government Way
Hayden, ID 83835-9280
Phone
(208) 457-4211
Fax
(208) 773-1473
NPI assigned
Sep 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2024

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

Authorized official

Name
Wendy Thomson
Title
Administrator
Phone
(480) 447-3579

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

8552 N Government Way
Hayden, ID 83835-9280

Mailing address

8552 N Government Way
Hayden, ID 83835-9280

Other names 1

  • Hayden Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240318002301 ID Part B Supplier - Ambulatory Surgical Center 8921445677 Receives reassigned benefits from 7 practitioners
Practice locations: Hayden, ID

Ambulatory surgical center certification: CCN 13C0001106

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Northern Lakes Surgery Center, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jun 20, 2024
Last certification
Jun 6, 2024
Ownership / control type
Proprietary
Facility address
8552 N Government Way
Hayden, ID 83835

National Provider Directory

National Provider Directory
Tax ID family
Hayden Surgery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720137600000",
    "number": "1861271629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8552 N GOVERNMENT WAY",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8552 N GOVERNMENT WAY",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359280",
            "telephone_number": "208-457-4211",
            "fax_number": "208-773-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LAKES SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-21",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A",
        "authorized_official_last_name": "THOMSON",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "480-447-3579"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hayden Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hayden Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hayden, ID

Sources for this page

Verify at the official NPI Registry.