Retina Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

RETINA SURGERY CENTER

Practice address

8780 W Golf Rd Ste 102
Niles, IL 60714-5611

Phone

(847) 485-9990

NPI assigned

Jan 7, 2022

Last updated

Aug 13, 2024By 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

Jackie M Benacka

Title

Admin

Phone

(847) 297-8900

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912668260. Details of each certification follow.

• CCN 14C0001196 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 14C0001196

Legal name

Retina Surgery Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jan 10, 2024

Last certification

Jan 10, 2024

Ownership / control type

Proprietary

Facility address

8780 West Golf Rd
Niles, IL 60714

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

Practitioners 3

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.

• John C Michael, MD

  • Ophthalmology Physician
  • Crystal Lake, IL
  • NPI 1598872160
  NPD
• Hong-Gam Le, M.D.

  • Ophthalmology Physician
  • Chicago, IL
  • NPI 1831552272
  NPD (past)
• Susan G Vierling, M.D.

  • Ophthalmology Physician
  • Lombard, IL
  • NPI 1306825930
  NPD (past)

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

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1912668260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8780 W GOLF RD STE 102",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607145611",
            "telephone_number": "847-485-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8780 W GOLF RD STE 102",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607145611",
            "telephone_number": "847-485-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-07",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "BENACKA",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "847-297-8900"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reitna Institute of Illinois
• Andrzej Remiasz
• Restore Rehab Inc
• Resurrection Services (Niles Medical Association)
• Retina Institute of Illinois PC
• Retinalysis, Inc.
• Jennifer Jiyun Rhee, PTA
• Nikola Ristic, PHARMD
• Jose Antonio Rivas-Perez, LCSW
• Annaliza Gaye Rivera, PT

• Ambulatory Surgical Clinic/Center in Niles, IL
• Providers in Niles, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.