SURGERY CENTER OF ST. JOSEPH, LLC – Ambulatory Surgical Clinic/Center, NPI 1104857523
Ambulatory Surgical Clinic/Center
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SURGERY CENTER OF ST. JOSEPH, LLC
Ashland Avenue, South Bend, Saint Joseph County, Indiana, 46616, United States
SAINT JOSEPH, MO 645061504
Phone: (816) 279-0079
Fax: (816) 901-0403
Mailing address matches the actual address.
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.
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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: 2006-08-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-09-30 (984 days ago).
Enrollment records
1
Earliest due date
2023-09-30
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 |
|---|---|---|---|---|
| O20060817000311 | O | Ambulatory Surgical Center | MO | 2023-09-30 |
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 |
|---|---|---|---|---|
| J2403 | Chloroprocaine hcl ophthalmic, 3% gel, 1 mg | 16,000 | 17 | $0 |
| J7351 | Injection, bimatoprost, intracameral implant, 1 microgram | 390 | 27 | $0 |
| 66984 | Removal of cataract with insertion of prosthetic lens | 158 | 90 | $0 |
| 66821 | Removal of recurring cataract in lens capsule using a laser | 143 | 91 | $0 |
| 66030 | Injection of medication into eye | 39 | 27 | $0 |
Insurance plans in this area (ZIP 64506)
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