St Joseph Center for Outpatient Surgery, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1332 Issued in MO

Legal business name

ST JOSEPH CENTER FOR OUTPATIENT SURGERY, LLC

Practice address

4510 Frederick Ave
Saint Joseph, MO 64506-3238

Phone

(816) 364-9992

Fax

(816) 364-9996

NPI assigned

Apr 12, 2006

Last updated

Apr 29, 2025By 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

Alicia Edwards

Title

Administrator

Phone

(816) 364-9992

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Listed as

St Joseph Center for Outpatient Surgery LLCCCN 26C0001075

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 1

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

• Heartland Regional Medical Center

  dba Mosaic Life Care

  • General Practice Physician
  • Saint Joseph, MO
  • NPI 1477575405

  Member Of

  NPD member

Practitioners 2

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.

• Judd Michael Smith, M.D.

  • Orthopaedic Surgery Physician
  • Saint Joseph, MO
  • NPI 1316280944
  NPD
• Blake Peterson, MD

  • Orthopaedic Surgery Physician
  • Arlington, VA
  • NPI 1023379849
  NPD (past)

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1891759569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 FREDERICK AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063238",
            "telephone_number": "816-364-9992",
            "fax_number": "816-364-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 FREDERICK AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063238",
            "telephone_number": "816-364-9992",
            "fax_number": "816-364-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH CENTER FOR OUTPATIENT SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-12",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "816-364-9992"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "1332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gita G Sprague, M.D.
• Makaylla Raeanne Sprake
• Cole R Spresser, M.D.
• Douglas Edward Sprouse, MASTERS IN SOCIAL WO
• St Joe Therapist LLC
• St Joseph Foot Clinic LLC (St Joseph Foot Clinic)
• St Joseph Neurology
• St Joseph Oncology Inc
• St Joseph Orthopedic Associates Inc
• St. Joe Health Care and Wellness, LLC

• Ambulatory Surgical Clinic/Center in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; 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.