Amelia Island Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

AMELIA ISLAND SURGERY CENTER LLC

Practice address

2416 Lynndale Rd
Fernandina Beach, FL 32034-5201

Phone

(904) 261-5741

NPI assigned

Jan 30, 2021

Organization subpart

No

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

Authorized official

Name

Dr. J. Russell Stackhouse, MD

Title

Manager

Phone

(904) 261-5741

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 5

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Amelisa Island Surgery Center LLCCCN 10C0001670

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.

• James Russell Keller Stackhouse, MD

  • Ophthalmology Physician
  • Fernandina, FL
  • NPI 1750517710
  NPD

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

{
    "created_epoch": "1611964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1972194199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 W INDIANTOWN RD STE 101",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334586834",
            "telephone_number": "561-630-6277",
            "fax_number": "561-630-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 LYNNDALE RD",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320345201",
            "telephone_number": "904-261-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMELIA ISLAND SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-30",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "STACKHOUSE",
        "authorized_official_first_name": "J.",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-261-5741",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "2416",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.aisc.com",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "billing",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "billing files",
            "address_1": "2416 Lynndale Rd",
            "city": "Fernandina Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320345201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.aisc.com",
            "affiliation": "N",
            "address_1": "2416 Lynndale Rd",
            "city": "Fernandina Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320345201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.aisc.com",
            "affiliation": "N",
            "endpointDescription": "billing",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "billing",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "billing files",
            "address_1": "2416 Lynndale Rd",
            "city": "Fernandina Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320345201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.pfs-elink.com",
            "affiliation": "N",
            "endpointDescription": "coder",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "billing",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "billing files",
            "address_1": "2416 Lynndale Rd",
            "city": "Fernandina Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320345201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.sdsiasc.com",
            "affiliation": "N",
            "endpointDescription": "company website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "none",
            "address_1": "2416 Lynndale Rd",
            "city": "Fernandina Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320345201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amelia Island Optics, LLC
• Amelia Island Orthpedics
• Amelia Island Outpatient Surgery Center LLC
• Amelia Island Senior Wellness LLC
• Amelia Island Surgery Center LLC
• Amelia Perfect Smiles
• Amelia Psychological Services, LLC
• Amelia Respiratory and Sleep Medicine LLC
• Amelia Therapy Services, Inc
• Amelia Urgent Care LLC

• Ambulatory Surgical Clinic/Center in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.