Surgcenter at National Harbor, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGCENTER AT NATIONAL HARBOR, LLC

Doing business as

Harborside Surgery Center

Practice address

125 Potomac Passage
Suite 200
National Harbor, MD 20745-1580

Phone

(703) 674-9041

NPI assigned

May 17, 2012

Last updated

May 17, 2012By 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

Ms. Daniela Booton, RN

Title

Administrator

Phone

(703) 674-9041

Specialties & licenses 1

Addresses

Other names 1

• Harborside Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Listed as

Harborside Surery Center LLCCCN 21C0001535

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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.

• Corey J Wallach, MD

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  NPD (past)

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

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337212800000",
    "number": "1912267592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 POTOMAC PASS.",
            "address_2": "SUITE 200",
            "city": "NATIONAL HARBOR",
            "state": "MD",
            "postal_code": "207451580",
            "telephone_number": "703-674-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 POTOMAC PASSAGE",
            "address_2": "SUITE 200",
            "city": "NATIONAL HARBOR",
            "state": "MD",
            "postal_code": "207451580",
            "telephone_number": "703-674-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGCENTER AT NATIONAL HARBOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-17",
        "last_updated": "2012-05-17",
        "status": "A",
        "authorized_official_last_name": "BOOTON",
        "authorized_official_first_name": "DANIELA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-674-9041",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harborside Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in National Harbor, MD
• Providers in National Harbor, 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 May 17, 2012; 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.