Surgery Center at Grove Creek, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGERY CENTER AT GROVE CREEK, LLC

Practice address

2168 W Grove Pkwy Ste 101
Pleasant Grove, UT 84062-6745

Phone

(801) 772-5050

NPI assigned

Dec 1, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Brian Shelton

Title

Board Member

Phone

(801) 772-5050

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Listed as

Surgery Center at Grove Creek LLCCCN 46C0001069

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 1

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

• John R Edwards, MD

  • Neurological Surgery Physician
  • Lehi, UT
  • NPI 1568692887
  NPD (past)

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1962007757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2168 W GROVE PKWY STE 101",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840626745",
            "telephone_number": "801-772-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2168 W GROVE PKWY STE 101",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840626745",
            "telephone_number": "801-772-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER AT GROVE CREEK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "SHELTON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "801-772-5050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• G Kelli Stout, CSW
• Jeannie Leigh Streadbeck
• Morgan Jane Stroh
• Meadow Romney Summers, PA-C
• Kaylene Sundquist
• Joshua Swallow, LMFT
• Abigail Swanson, CSW
• Elsie Marie Swiderski
• Bethany H Tait, MS, RDN
• Ernie Carl Taylor

• Ambulatory Surgical Clinic/Center in Pleasant Grove, UT
• Providers in Pleasant Grove, UT by specialty
• Ambulatory Surgical Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; 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.