St Joseph Center for Outpatient Surgery, LLC

Key facts

NPI: 1891759569
Entity type: Organization (NPI type 2)
Primary specialty: Ambulatory Surgical Clinic/Center 261QA1903X
License: 1332 (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
Organization subpart: No

Authorized official

Name: Alicia Edwards
Title: Administrator
Phone: (816) 364-9992

Member of 1

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

Heartland Regional Medical Center General Acute Care Hospital · Saint Joseph, MO · NPI 1437259694

NPD member Member Of

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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)

Medicare Care Compare: Ambulatory surgical center

Listed as: St Joseph Center for Outpatient Surgery LLC CCN 26C0001075
Medicare certification status: Active (Provider of Services file)

Source: Medicare Care Compare.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
26D1017314	St Joseph Ctr for Outpatient Surgery 4510 Frederick Blvd, Saint Joseph, MO 64506	Certificate of waiver	Sep 21, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MO

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20031215000966	MO	Part B Supplier - Ambulatory Surgical Center	0941107239	Practice locations: Saint Joseph, MO

National Provider Directory

Locations

4510 Frederick Ave
Saint Joseph, MO 64506
Phone (816) 233-1629

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Ambulatory Surgical Clinic/Center	261QA1903X	1332	MO	Yes

Addresses

Primary practice location

4510 Frederick Ave
Saint Joseph, MO 64506-3238

Mailing address

4510 Frederick Ave
Saint Joseph, MO 64506-3238
Phone (816) 364-9992

Other providers in Saint Joseph, MO

Kerri Louise Spitzer, PLPC
Gita G Sprague, M.D.
Cole R Spresser, M.D.
Douglas Edward Sprouse, MASTERS IN SOCIAL WO
St Joe Therapist LLC
St Joseph Foot Clinic LLC
St Joseph Neurology
St Joseph Oncology Inc
St Joseph Orthopedic Associates Inc
St. Joe Health Care and Wellness, LLC

All providers in Saint Joseph, MO · Ambulatory Surgical Clinic/Center in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2025. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.