Breckenridge Surgery Center LP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BRECKENRIDGE SURGERY CENTER LP

Practice address

3201 E President George Bush Hwy
Suite 100
Richardson, TX 75082-3566

Phone

(972) 470-5859

Fax

(972) 470-5861

NPI assigned

Dec 28, 2006

Organization subpart

No

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

Authorized official

Name

Miss Mamie Sue Clark

Title

Or Director

Phone

(972) 470-5859

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Breckenridge Surgery CenterCCN 45C0001381

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 1

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

• Denton Watumull, MD

  • Plastic and Reconstructive Surgery Physician
  • Richardson, TX
  • NPI 1225073216
  NPD (past)

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1962568725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 E PRESIDENT GEORGE BUSH HWY",
            "address_2": "SUITE 100",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750823566",
            "telephone_number": "972-470-5000",
            "fax_number": "972-470-5861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 E PRESIDENT GEORGE BUSH HWY",
            "address_2": "SUITE 100",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750823566",
            "telephone_number": "972-470-5859",
            "fax_number": "972-470-5861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRECKENRIDGE SURGERY CENTER LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2022-07-21",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MAMIE",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OR DIRECTOR",
        "authorized_official_telephone_number": "972-470-5859",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "ASC239",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHEILD",
            "identifier": "HHO67A",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby Chrisitan Bratton, FNP-C
• Lauren Nicole Braun, PA-C
• Korbin Andrew Bray, MD
• Laura Wellborn Bray, M.S., CCC-SLP
• Breathe & Sleep to Live, PLLC
• Breckinridge Dental and Orthodontics
• Neil Matthew Breese
• Nonnie Breytspraak, FNP-C
• Nichole Brezel
• Brian G Farrell, PC

• Ambulatory Surgical Clinic/Center in Richardson, TX
• Providers in Richardson, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.