Archibald Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ARCHIBALD SURGERY CENTER, LLC

Practice address

9674 Archibald Ave
Suite 125
Rancho Cucamonga, CA 91730-7944

Phone

(909) 989-4100

Fax

(909) 989-5400

NPI assigned

Jan 23, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Sunil M Shivaram, M.D.

Title

Medical Director

Phone

(909) 624-8077

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospital certification: CCN 050799

Legal name

ARCHIBALD SURGERY CENTER, LLC

Certification status

Terminated Voluntary: merger or closure, May 11, 2023

Provider type (POS)

Hospital – Short-term

Participating since

Apr 23, 2020

Last certification

Apr 23, 2020

Beds

1

Ownership / control type

Private (for profit)

Facility address

9674 Archibald Avenue, Suite 125
Cucamonga, CA 91730

Listed as

Archibald Surgery Center LLCCCN 05C0001584

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1982975959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9674 ARCHIBALD AVE",
            "address_2": "SUITE 125",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307944",
            "telephone_number": "909-296-8930",
            "fax_number": "909-296-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9674 ARCHIBALD AVE",
            "address_2": "SUITE 125",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307944",
            "telephone_number": "909-989-4100",
            "fax_number": "909-989-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARCHIBALD SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-23",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "SHIVARAM",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "909-624-8077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pslam Antoinette Nera Arcena
• Destiny Arceo
• Maraya Elizabeth Arceo
• Jessica Mercado Archambault, O.D.
• Archibald Hospice Inc
• Madelyn Archibald
• Nena Tong Arciaga
• Salvador Ardon, PH.D.,LMFT
• Emily Arechiga
• Irving Arellano Taizan, RBT

• Ambulatory Surgical Clinic/Center in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; 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.
• 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.