SURGCENTER OF GREATER JACKSONVILLE, LLC – Ambulatory Surgical Clinic/Center, NPI 1104485440
Ambulatory Surgical Clinic/Center
Main info
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SURGCENTER OF GREATER JACKSONVILLE, LLC
692 CHESTWOOD CHASE DR
ORANGE PARK, FL 320652572
Phone:
Type: Mailing
9143 PHILIPS HWY STE 500
JACKSONVILLE, FL 322561335
Phone: (904) 233-0597
Type: Mailing
Philips Highway, Clarksville, Jacksonville, Duval County, Florida, United States
JACKSONVILLE, FL 322561335
Phone: (904) 233-0597
Type: Location
14201 DALLAS PKWY
DALLAS, TX 752542916
Phone: (469) 893-2500
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-08-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-02-28 (105 days ago).
Enrollment records
1
Earliest due date
2026-02-28
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20190814003750 | O | Ambulatory Surgical Center | FL | 2026-02-28 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| C9290 | Injection, bupivacaine liposome, 1 mg | 6,251 | 24 | $0 |
| 27447 | Replacement of knee joint, both sides of knee | 20 | 20 | $0 |
| 27130 | Replacement of thigh bone and hip joint with prosthesis | 12 | 11 | $0 |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 12 | 12 | $0 |
Insurance plans in this area (ZIP 32065)
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