SURGICAL ASSOCIATES OF NE KS – Surgery Physician, NPI 1912930660
Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SURGICAL ASSOCIATES OF NE KS
East 10th Street, Interlaken West, Waconia, Carver County, Minnesota, 55387, United States of America
WACONIA, MN 553874552
Phone: (952) 442-9770
Fax: (952) 442-3620
Type: Mailing
Hiawatha Community Hospital, 300, Utah Street, Hiawatha, Brown County, Kansas, 66434, United States
HIAWATHA, KS 664342314
Phone: (785) 742-2131
Fax: (952) 442-3620
Type: Location
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: 2004-04-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-09-30 (252 days ago).
Enrollment records
2
Earliest due date
2025-09-30
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 |
|---|---|---|---|---|
| O20040407000851 | O | Clinic/Group Practice | KS | 2025-09-30 |
| O20040421001281 | O | Clinic/Group Practice | NE | 2025-10-31 |
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55387)
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