KC Surgicenter, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

KC SURGICENTER, LLC

Doing business as

Blue River Surgery Center

Practice address

1318 E 104TH Street
Kansas City, MO 64131

Phone

(816) 256-5200

Fax

(816) 256-5199

NPI assigned

Nov 15, 2023

Organization subpart

No

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

Authorized official

Name

David McKnight

Title

VP/Cfo

Phone

(972) 789-2816

Specialties & licenses 1

Addresses

Other names 1

• Blue River Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Listed as

KC Surgicenter LLC Dba Blue River Surgery CenterCCN 26C0001181

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

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

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788912000000",
    "number": "1962277483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1318 E 104TH ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641314504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 E 104TH STREET",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64131",
            "telephone_number": "816-256-5200",
            "fax_number": "816-256-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KC SURGICENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-15",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A",
        "authorized_official_last_name": "MCKNIGHT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "972-789-2816"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue River Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue River Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; 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.