Sacred Heart ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SACRED HEART ASC, LLC

Practice address

1890 Summit Boulevard
Suite 210
Pensacola, FL 32503

Phone

(833) 419-1325

Fax

(844) 853-5049

NPI assigned

Jun 26, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Coy Wells

Title

Manager

Phone

(205) 999-2864

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Summit Surgery CenterCCN 10C0001676

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 3

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

• Consolidated Pharmacy Services

  • Durable Medical Equipment & Medical Supplies
  • Jacksonville, FL
  • NPI 1013126978

  Member Of

  NPD member
• St Vincents Health System Inc

  • General Acute Care Hospital
  • St. Johns, FL
  • NPI 1861078651

  Member Of

  NPD member
• St Vincents Medical Center Inc

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1134117575

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1891312815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 SUMMIT BOULEVARD",
            "address_2": "SUITE 210",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "32503",
            "telephone_number": "833-419-1325",
            "fax_number": "844-853-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 SUMMIT BOULEVARD",
            "address_2": "SUITE 210",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "32503",
            "telephone_number": "833-419-1325",
            "fax_number": "844-853-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED HEART ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-26",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "COY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "205-999-2864",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sackheim Dental PLLC
• Lara Carlson Sackheim, DMD
• Robert Morris Sackheim, MD
• William Eric Sackheim, DMD
• Alan I. Sacks, MD
• Sacred Heart Health System
• Sacred Heart Health System
• Sacred Heart Health System
• Sacred Heart Health System Inc
• Sacred Heart Health System Inc

• Ambulatory Surgical Clinic/Center in Pensacola, FL
• Providers in Pensacola, 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 Jul 20, 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.