Saint Mary'S Ambulatory Surgery

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SAINT MARY'S AMBULATORY SURGERY

Practice address

540 Bergen Blvd
Palisades Park, NJ 07650

Phone

(201) 585-2911

Fax

(201) 585-2977

NPI assigned

Mar 8, 2006

Organization subpart

No

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

Authorized official

Name

Daniel Kim, M.D.NPI 1477500866

Title

Medical Director

Phone

(201) 585-2911

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Listed as

Saint Marys Ambulatory Surgery Dba Saint Marys Ambulatory Surgery LLCCCN 31C0001186

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

Locations

Practitioners 1

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

• Daniel Y Kim, M.D.

  • Ophthalmology Physician
  • Palisades Park, NJ
  • NPI 1477500866
  NPD (past) Authorized official

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314144000000",
    "number": "1922075969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 BERGEN BLVD",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076502322",
            "telephone_number": "201-585-2911",
            "fax_number": "201-585-2977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 BERGEN BLVD",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "07650",
            "telephone_number": "201-585-2911",
            "fax_number": "201-585-2977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT MARY'S AMBULATORY SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2011-08-24",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "201-585-2911",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON BCBS",
            "identifier": "311186",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2628993",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0084361",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "A3608737",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Palisades Park, NJ
• Providers in Palisades Park, NJ by specialty
• Ambulatory Surgical Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; 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.