Optimum Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

OPTIMUM SURGICAL CENTER, LLC

Practice address

20045 N 19TH Ave BLDG 12
Phoenix, AZ 85027-4270

Phone

(480) 766-6819

NPI assigned

Apr 9, 2017

Organization subpart

No

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

Authorized official

Name

Grant Cook

Title

Owner/Manager

Phone

(602) 313-8110

Specialties & licenses 1

Addresses

Other names 1

• Nascent Paradise Valley Surgical Center Former legal business name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Listed as

Optimum Surgical CenterCCN 03C0001399

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.

• Banner Health

  • Critical Access Hospital
  • Payson, AZ
  • NPI 1063923340

  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.

• Christine Samir Haddad, M.D., PHD

  • Pain Medicine Physician
  • Phoenix, AZ
  • NPI 1972965168
  NPD (past)

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

{
    "created_epoch": "1491696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587600000000",
    "number": "1992238661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15333 N PIMA RD",
            "address_2": "SUITE 305",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852602783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20045 N 19TH AVE BLDG 12",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850274270",
            "telephone_number": "480-766-6819"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6245 N 16th St",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850161706",
            "country_code": "US",
            "telephone_number": "480-766-6819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTIMUM SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-09",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "602-313-8110"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nascent Paradise Valley Surgical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; 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.