Costa Mesa Surgery Center Inc

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

COSTA MESA SURGERY CENTER INC

Practice address

720 Paularino Ave Ste 100
Costa Mesa, CA 92626-6917

Phone

(213) 383-4800

NPI assigned

Aug 8, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Peter G Lee, MDNPI 1326279605

Title

Owner

Phone

(213) 383-4800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 55C0001117

Legal name

Costa Mesa Surgery Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Sep 23, 2022

Last certification

Aug 23, 2022

Ownership / control type

Proprietary

Facility address

720 Paularino Ave.
Costa Mesa, CA 92626

Locations

Practitioners 1

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

• Peter Geon Lee, M.D.

  • Specialist
  • Los Angeles, CA
  • NPI 1326279605
  NPD (past) Authorized official

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

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533686400000",
    "number": "1982183299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3680 WILSHIRE BLVD STE 206",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102714",
            "telephone_number": "213-383-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 PAULARINO AVE STE 100",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926266917",
            "telephone_number": "213-383-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTA MESA SURGERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-08",
        "last_updated": "2018-08-08",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "213-383-4800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Costa Mesa Corp.
• Costa Mesa Healthcare Inc.
• Costa Mesa Medical Clinic
• Costa Mesa Operations LLC
• Costa Mesa Oral Surgery
• Costa Victoria Healthcare LLC
• Leticia P Costa, RDN
• Erin Costello
• Carlos Cota Jr.
• Devony Bernadette Cota

• Surgery Physician in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.