NPIMap

Organization Active NPI

Family Surgery Center, LLC

  • Anesthesiology Physician
  • Willmar, MN
National Provider Identifier
1962583369
Registry record updated Jun 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
330845 Issued in MN
Legal business name
FAMILY SURGERY CENTER, LLC
Practice address
1801 19TH Ave SW
Willmar, MN 56201-4946
Phone
(320) 235-7700
Fax
(320) 235-7701
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2012

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

Authorized official

Name
Mrs. Carmen Macik
Title
Administrator
Phone
(320) 214-5759

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X 330845 MN Primary

Addresses

Primary practice location

1801 19TH Ave SW
Willmar, MN 56201-4946

Mailing address

1801 19TH Ave SW
Willmar, MN 56201-4946
Phone (320) 235-7700

Other identifiers 1

IdentifierTypeStateIssuer
277A0FAOtherMNBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050930000467 MN Part B Supplier - Ambulatory Surgical Center 8022043785 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Willmar, MN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Family 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.

Member of 2

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

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339459200000",
    "number": "1962583369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 19TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014946",
            "telephone_number": "320-235-7700",
            "fax_number": "320-235-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 19TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014946",
            "telephone_number": "320-235-7700",
            "fax_number": "320-235-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2012-06-12",
        "status": "A",
        "authorized_official_last_name": "MACIK",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "320-214-5759",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "330845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "277A0FA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Willmar, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.