South Bend Specialty Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTH BEND SPECIALTY SURGERY CENTER, LLC

Practice address

335 Florence Ave
Suite 1B
Granger, IN 46530-8049

Phone

(574) 217-0058

Fax

(574) 272-3901

NPI assigned

Oct 23, 2012

Organization subpart

No

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

Authorized official

Name

Ralph E Lantz, RN BSN, MBA

Title

Administrator

Phone

(574) 606-6329

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

South Bend Specialty Surgery CenterCCN 15C0001185

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

Member of 1

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

• Beacon Health Ventures Inc

  • Home Infusion Therapy Pharmacy
  • South Bend, IN
  • NPI 1790859403

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1350950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1992058325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 FLORENCE AVE",
            "address_2": "SUITE 1B",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308049",
            "telephone_number": "574-217-0058",
            "fax_number": "574-272-3901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 FLORENCE AVE",
            "address_2": "SUITE 1B",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308049",
            "telephone_number": "574-217-0058",
            "fax_number": "574-272-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BEND SPECIALTY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-23",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "LANTZ",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "574-606-6329",
        "authorized_official_credential": "RN BSN, MBA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keziban Slisher, OTR
• Ben N Smith IV, PHD
• Savannah Elaine Smith
• Steve Smith
• Paul A Smucker, MD
• South Bend Wellness Center LLC
• Patrick E Southe, MD
• Spine & Orthopedic Medicine, Inc
• St Joseph County - Harris Civil Township
• Stacey Counseling Associates LLC

• Ambulatory Surgical Clinic/Center in Granger, IN
• Providers in Granger, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.