SURGERY CENTER OF ST. JOSEPH, LLC
NPI 1104857523
Clinic/Center - Ambulatory Surgical in Saint Joseph, MO

Q: What is Surgery Center Of St. Joseph, LLC's NPI number?

The NPI number for Surgery Center Of St. Joseph, LLC is 1104857523. It was assigned to this organization in the NPPES registry on July 5, 2006.

Q: What is Surgery Center Of St. Joseph, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Active since July 05, 2006CLIA 26D0707725 · Waiver

3201 ASHLAND AVE, SAINT JOSEPH, MO 64506(816) 279-0079(816) 364-1100 Get Directions Write a Review

NPPES record last updated: April 5, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Surgery Center Of St. Joseph, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SURGERY CENTER OF ST. JOSEPH, LLC (NPI 1104857523) is a healthcare organization registered as an ambulatory surgical in Saint Joseph, Missouri and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2028 and lists Angela J Fry, Clinic Director, as its authorized official.

NPPES Registry Identity

NPI1104857523

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NameSURGERY CENTER OF ST. JOSEPH, LLC

Location Address3201 ASHLAND AVESaint Joseph, MO 64506-1504

Mailing Address3201 Ashland AveSaint Joseph, MO 64506-1504 · (816) 279-0079 · Fax (816) 901-0403

Phone(816) 279-0079

Fax(816) 364-1100

Organization SubpartNo

Authorized OfficialAngela J FryClinic Director · (816) 279-0079

Enumeration DateJuly 5, 2006

Last NPPES UpdateApril 5, 2012

✔ NPI 1104857523 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

License✔ Licensed in MO · 119-3

3201 ASHLAND AVE, Saint Joseph, MO 64506

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Other Identifiers 3

Medicare ID-Type Unspecified9004187MO

Other26C0001012MO · Medicare Supplier

Medicaid502343502MO

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Kansas City, Oscar Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Surgery Center Of St. Joseph, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Surgery Center Of St. Joseph, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Christopher Pole, M.D.

Ophthalmology

NPI 1285883231

5520 COLLEGE BLVD STE 201
Overland Park, KS 66211

(913) 491-3737

✔ PECOS✔ Accepts Medicare61 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D0707725

Surgery Center Of St Joseph · Saint Joseph, MO

Active · expires Aug 31, 2028

CLIA Number26D0707725

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateSeptember 1, 2026

Certificate Expiration DateAugust 31, 2028

Laboratory DirectorStephen Wiles

Laboratory Phone(816) 279-0079

Laboratory LocationSurgery Center Of St Joseph3201 Ashland Avenue, Saint Joseph, MO 64506

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Injection, bimatoprost, intracameral implant, 1 microgram J7351

This procedure involves placing a tiny implant inside the eye, which releases a drug called bimatoprost. This drug helps to lower high pressure in the eye, typically seen in conditions like glaucoma. It's a safe and effective treatment.

360 services26 patients

Removal of recurring cataract in lens capsule using a laser 66821

This procedure, known as YAG laser capsulotomy, treats cloudiness in the lens capsule following cataract surgery. A laser is used to create a small hole in the cloudy capsule, allowing light to pass through and restore clear vision. It's a quick, painless procedure.

135 services88 patients

Removal of cataract with insertion of prosthetic lens 66984

This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.

124 services69 patients

Injection of medication into eye 66030

This procedure involves administering medication directly into your eye. A tiny needle is used to deliver the drug into the vitreous, a jelly-like substance in the eye. It helps treat conditions like macular degeneration or diabetic retinopathy. It's generally safe and effective.

36 services26 patients

Extracapsular removal of cataract with insertion of artificial lens and insertion of drainage device in front chamber of eye 66991

This is a two-part eye procedure. First, a cloudy lens (cataract) is removed from its outer layer and replaced with an artificial lens to improve vision. Second, a drainage device is inserted into the front part of the eye to manage fluid levels, preventing pressure build-up.

20 services11 patients

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Surgery Center Of St. Joseph, LLC's NPI number?

The NPI number for Surgery Center Of St. Joseph, LLC is 1104857523. It was assigned to this organization in the NPPES registry on July 5, 2006.

Where is Surgery Center Of St. Joseph, LLC located?

Surgery Center Of St. Joseph, LLC is located at 3201 Ashland Ave, Saint Joseph, MO 64506. The listed phone number is (816) 279-0079.

What is Surgery Center Of St. Joseph, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Is Surgery Center Of St. Joseph, LLC enrolled in Medicare?

Yes. Surgery Center Of St. Joseph, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Surgery Center Of St. Joseph, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Ophthalmology) reassigns their Medicare billing to Surgery Center Of St. Joseph, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Surgery Center Of St. Joseph, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D0707725) is associated with this NPI, valid through August 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Surgery Center Of St. Joseph, LLC accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Kansas City and Oscar Insurance Company list Surgery Center Of St. Joseph, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Surgery Center Of St. Joseph, LLC was last updated on April 5, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.