Lake Ridge Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

LAKE RIDGE AMBULATORY SURGERY CENTER, LLC

Practice address

12825 Minnieville Road
Suite 204
Woodbridge, VA 22192

Phone

(703) 357-9568

Fax

(703) 357-9575

NPI assigned

Aug 9, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Janet M Smith, RN

Title

Administrator

Phone

(703) 357-9568

Specialties & licenses 1

Addresses

Other names 1

• Lake Ridge Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Listed as

Lake Ridge Ambulatory Surgery Center LLCCCN 49C0001059

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

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

• Potomac Hospital Corporation of Prince William

  • General Acute Care Hospital
  • Woodbridge, VA
  • NPI 1548366404

  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.

• Edward Charles Rabbitt, M.D.

  • Orthopaedic Surgery Physician
  • Alexandria, VA
  • NPI 1053342592
  NPD (past)

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388102400000",
    "number": "1972850808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12825 MINNIEVILLE ROAD",
            "address_2": "SUITE 204",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-357-9568",
            "fax_number": "703-357-9575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12825 MINNIEVILLE ROAD",
            "address_2": "SUITE 204",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-357-9568",
            "fax_number": "703-357-9575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE RIDGE AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-09",
        "last_updated": "2013-12-27",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-357-9568",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Ridge Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• La Mazon Training Center Incorporated
• Labbaf Neurology LLC
• Mohammadhamed Labbaf, M.D.
• Laboratory Corporation of America
• Paula A Labriola, M.D.
• Lake Ridge Anesthesia LLC
• Lake Ridge Dental Care
• Lake Ridge Endodontics
• Lake Ridge Internal Medicne, PC
• Lake Ridge Ophthalmology LLC

• Ambulatory Surgical Clinic/Center in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Ambulatory Surgical Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2013; 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.