NPIMap

Organization Active NPI

Upper Mississippi Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Hazel Green, WI
National Provider Identifier
1952153991
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
UPPER MISSISSIPPI SURGERY CENTER, LLC
Practice address
454 Badger Road
Hazel Green, WI 53811
Phone
(608) 473-1700
NPI assigned
Apr 3, 2024
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Susan Gourley, RN
Title
Administrator
Phone
(608) 473-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

454 Badger Road
Hazel Green, WI 53811

Mailing address

454 Badger Road
Hazel Green, WI 53811
Phone (608) 473-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240917002915 WI Part B Supplier - Ambulatory Surgical Center 4486195534 Receives reassigned benefits from 1 practitioner
Practice locations: Hazel Green, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952153991. Details of each certification follow.

Ambulatory surgical center certification: CCN 52C0001158

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Upper Mississippi Surgery Center
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Apr 1, 2025
Last certification
Apr 1, 2025
Ownership / control type
Proprietary
Facility address
454 Badger Rd.
Hazel Green, WI 53811

National Provider Directory

National Provider Directory
Tax ID family
Upper Mississippi Surgery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1952153991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 BADGER ROAD",
            "city": "HAZEL GREEN",
            "state": "WI",
            "postal_code": "53811",
            "telephone_number": "608-473-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 BADGER ROAD",
            "city": "HAZEL GREEN",
            "state": "WI",
            "postal_code": "53811",
            "telephone_number": "608-473-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER MISSISSIPPI SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-01",
        "status": "A",
        "authorized_official_last_name": "GOURLEY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "608-473-1700",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazel Green, WI

Sources for this page

Verify at the official NPI Registry.