Fullerton Surgical Center, LP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

550000031 Issued in CA

Legal business name

FULLERTON SURGICAL CENTER, LP

Practice address

2240 North Harbor Blvd.
Suite 100
Fullerton, CA 92835-8300

Phone

(714) 870-8300

Fax

(714) 870-8301

NPI assigned

Jul 21, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Phillip A Clendenin

Title

President of LP

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Other names 1

• Fullerton Surgical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospital certification: CCN 050816

Legal name

FULLERTON SURGICAL CENTER

Certification status

Terminated Voluntary: other reason for withdrawal, Mar 1, 2023

Provider type (POS)

Hospital – Short-term

Participating since

Aug 28, 2020

Last certification

Aug 28, 2020

Beds

1

Ownership / control type

Private (for profit)

Facility address

2240 Harbor Blvd, Suite 100
Fullerton, CA 92835

Listed as

Fullerton Surgical CenterCCN 05C0001715

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• St Jude Hospital Inc

  • General Acute Care Hospital
  • Brea, CA
  • NPI 1891904942

  Member Of

  NPD member

Practitioners 1

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

• Steven S Shin, M.D.

  • Orthopaedic Hand Surgery Physician
  • Los Angeles, CA
  • NPI 1164407862
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1962423574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BURTON HILLS BLVD.",
            "address_2": "SUITE 500 ATTN: L&C",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156176",
            "telephone_number": "615-240-3820",
            "fax_number": "615-234-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 NORTH HARBOR BLVD.",
            "address_2": "SUITE 100",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928358300",
            "telephone_number": "714-870-8300",
            "fax_number": "714-870-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON SURGICAL CENTER, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "CLENDENIN",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT OF LP",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "550000031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fullerton Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fullerton Physical Therapy & Sports Care, Inc.
• Fullerton Plaza Guest Home
• Fullerton Pulmonary & Critical Care Inc
• Fullerton Rosewood Assisted Living, Inc.
• Fullerton School District
• Caroline Fung
• William Funke
• Katherina Alexis Furlow, DDS
• Cynthia Furman, PHARM.D.
• G.I.F.T. Inc.

• Ambulatory Surgical Clinic/Center in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.