NPIMap

Organization Active NPI

Northeast Nebraska Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Norfolk, NE
National Provider Identifier
1861497380
Registry record updated Feb 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
NORTHEAST NEBRASKA SURGERY CENTER LLC
Practice address
2701 W Norfolk Ave
Ste 101
Norfolk, NE 68701-4408
Phone
(402) 644-7262
Fax
(402) 644-7227
NPI assigned
Jun 21, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2020

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

Authorized official

Name
Kelly A. Driscoll
Title
Member of Board of Managers
Phone
(402) 644-7637

Specialties & licenses 1

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

Addresses

Primary practice location

2701 W Norfolk Ave
Ste 101
Norfolk, NE 68701-4408

Mailing address

2701 W Norfolk Ave
Ste 101
Norfolk, NE 68701-4408
Phone (402) 644-7262

Other identifiers 4

IdentifierTypeStateIssuer
0719674MedicaidIA
F885OtherNEMIDLANDS CHOICE
01307OtherNEBCBS
490004329OtherNERR MEDICARE

Other names 1

  • Faith Regional Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040405001010 NE Part B Supplier - Ambulatory Surgical Center 5890788004 Practice locations: Norfolk, NE

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Northeast Nebraska Surgery Center LLCCCN 28C0001018
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D0964358Northeast Nebraska Surgery Center Dba2701 W Norfolk Ave, Ste 101, Norfolk, NE 68701Certificate of waiverAug 23, 2027

National Provider Directory

National Provider Directory

Member of 1

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

Locations

2701 W Norfolk Ave
Ste 101
Norfolk, NE 68701
Phone (402) 644-7262

2701 W Norfolk Ave
Norfolk, NE 68701
Phone (402) 844-8158

301 N 27th St
#3
Norfolk, NE 68701
Phone (402) 644-7262

Practitioners & affiliated clinicians

Practitioners 12

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": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582502400000",
    "number": "1861497380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 W NORFOLK AVE",
            "address_2": "STE 101",
            "city": "NORFOLK",
            "state": "NE",
            "postal_code": "687014408",
            "telephone_number": "402-644-7262",
            "fax_number": "402-644-7227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 W NORFOLK AVE",
            "address_2": "STE 101",
            "city": "NORFOLK",
            "state": "NE",
            "postal_code": "687014408",
            "telephone_number": "402-644-7262",
            "fax_number": "402-644-7227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST NEBRASKA SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A",
        "authorized_official_last_name": "DRISCOLL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "MEMBER OF BOARD OF MANAGERS",
        "authorized_official_telephone_number": "402-644-7637"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0719674",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "F885",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01307",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "490004329",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Faith Regional Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Faith Regional Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norfolk, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.