Prime Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PRIME SURGERY CENTER

Practice address

4715 Statesmen Dr Ste a
Indianapolis, IN 46250-1997

Phone

(317) 932-3411

NPI assigned

Oct 10, 2022

Last updated

Dec 12, 2024By 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

Dr. Samiullah Kundi, M.D.NPI 1932249323

Title

Medical Director/Owner

Phone

(405) 408-6154

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881319127. Details of each certification follow.

• CCN 15C0002016 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 15C0002016

Legal name

PRIME SURGERY CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Nov 30, 2023

Last certification

Nov 30, 2023

Ownership / control type

Proprietary

Facility address

4715 Statesmen Drive
Indianapolis, IN 46250

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.

• Samiullah Khan Kundi, MD

  • Pain Medicine Physician
  • Indianapolis, IN
  • NPI 1932249323
  NPD Authorized official

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1881319127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4715 STATESMEN DR.",
            "address_2": "SUITE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501997",
            "telephone_number": "317-932-3411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 STATESMEN DR STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501997",
            "telephone_number": "317-932-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-10",
        "last_updated": "2024-12-12",
        "certification_date": "2022-10-10",
        "status": "A",
        "authorized_official_last_name": "KUNDI",
        "authorized_official_first_name": "SAMIULLAH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "405-408-6154",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Primary Care at Home, Inc.
• Primary Care Partners LLC
• Primary Personal Services LLC
• Prime Health Care Services LLC
• Prime Rose Healthcare Staffing, LLC
• Primecare Dental LLC
• Primecare Home Care Services of Indiana, LLC
• Primecare Labs LLC
• Primehealth of Indiana LLC
• Primelife Home Care LLC

• Ambulatory Surgical Clinic/Center in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.