Shady Grove Children'S Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SHADY GROVE CHILDREN'S SURGERY CENTER, LLC

Practice address

15001 Shady Grove Rd Ste 120
Rockville, MD 20850-6354

Phone

(301) 494-3000

NPI assigned

Jan 24, 2023

Organization subpart

No

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

Authorized official

Name

Jeffrey Wheeler

Title

Ceo

Phone

(301) 494-3000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Ambulatory surgical center certification: CCN 21C0001686

Legal name

Shady Grove Children's Surgery Center, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jan 15, 2025

Last certification

Nov 4, 2024

Ownership / control type

Proprietary

Facility address

15001 Shady Grove Rd. Ste. 110
Rockville, MD 20850

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1891401808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 CARAWAY CT STE 1050",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207745338",
            "telephone_number": "301-494-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15001 SHADY GROVE RD STE 120",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506354",
            "telephone_number": "301-494-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY GROVE CHILDREN'S SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-24",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-494-3000"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shady Grove Andrology Center LLC
• Shady Grove Anesthesia Associate LLC
• Shady Grove Center for Preimplantation Genetics
• Shady Grove Children'S Gad, LLC
• Shady Grove Children'S Gad, LLC
• Shady Grove Dental Center, LLC
• Shady Grove Dermatology
• Shady Grove Eye & Vision Care, LLC
• Shady Grove Family Health Care Inc
• Shady Grove Fertility Reproductive Science Center

• Ambulatory Surgical Clinic/Center in Rockville, MD
• Providers in Rockville, MD by specialty
• Ambulatory Surgical Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.
• 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.