NPIMap

Organization Active NPI

Jefferson Ambulatory Surgery Services, LLC

Doing business as Jeffeson Endoscopy Center at Bala

  • Endoscopy Clinic/Center
  • Bala Cynwyd, PA
National Provider Identifier
1972977627
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endoscopy Clinic/CenterTaxonomy code 261QE0800X
Legal business name
JEFFERSON AMBULATORY SURGERY SERVICES, LLC
Doing business as
Jeffeson Endoscopy Center at Bala
Practice address
130 Presidential Blvd
Bala Cynwyd, PA 19004-1110
Phone
(615) 397-9187
NPI assigned
Nov 18, 2015
Last updated
Oct 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Authorized official

Name
Mr. Richard Webster
Title
President
Phone
(215) 955-7937

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endoscopy Clinic/Center 261QE0800X PA Primary

Addresses

Primary practice location

130 Presidential Blvd
Bala Cynwyd, PA 19004-1110

Mailing address

111 S 11TH St
Ste. 2210
Philadelphia, PA 19107-4824

Other names 1

  • Jeffeson Endoscopy Center at Bala Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160321001620 PA Part B Supplier - Ambulatory Surgical Center 8527365451 Practice locations: Bala Cynwyd, PA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Jefferson Endoscopy Center at BalaCCN 39C0001322
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Ambulatory Surgery Services LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Locations

130 Presidential Blvd
Ste 100
Bala Cynwyd, PA 19004

111 S 11th St
Ste 2210
Philadelphia, PA 19107
Phone (609) 790-6631

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1972977627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "STE. 2210",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 PRESIDENTIAL BLVD",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041110",
            "telephone_number": "615-397-9187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON AMBULATORY SURGERY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-18",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "WEBSTER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-955-7937",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeffeson Endoscopy Center at Bala",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bala Cynwyd, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.