WEST LAKES SURGERY CENTER LLC
NPI 1104933696
Clinic/Center - Ambulatory Surgical in Clive, IA

NPI Status: Active since August 23, 2006

Contact Information

12499 UNIVERSITY AVE
SUITE 100
CLIVE, IA
ZIP 50325
Phone: (515) 974-5050

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  • Organization
  • Clinic/Center
  • Ambulatory Surgical
  • Accepts Insurance
  • CLIA Number: 16D1058574
  • CLIA Cert. Type: Ambulatory Surgery Center
  • CLIA Exp. Date: 09-07-2026

About WEST LAKES SURGERY CENTER LLC

This page provides the complete NPI Profile along with additional information for West Lakes Surgery Center Llc, a provider established in Clive, Iowa operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1104933696 assigned on August 2006. The practitioner's primary taxonomy code is 261QA1903X with license number NA (). The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Dr. Teri S Formanek M.d. (President)

NPI
1104933696
Provider Name
WEST LAKES SURGERY CENTER LLC
Entity Type
Organization
Location Address
12499 UNIVERSITY AVE SUITE 100 CLIVE, IA 50325
Location Phone
(515) 974-5050
Mailing Address
2808 S INGRAM MILL RD BUILDING B SPRINGFIELD, MO 65804
Mailing Phone
(417) 889-2040
Mailing Fax
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
08-23-2006
Last Update Date
06-04-2020
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Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Ambulatory Surgical

Taxonomy Code
261QA1903X
Type
Ambulatory Health Care Facilities
License No.
NA

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Medica Insure Bronze $0 Copay PCP Visits - EPO
  • Medica Insure Bronze Premier - EPO
  • Medica Insure Bronze Share - EPO
  • Medica Insure Expanded Bronze Standard - EPO
  • Medica Insure Gold $0 Copay PCP Visits - EPO
  • Medica Insure Gold Share - EPO
  • Medica Insure Gold Standard - EPO
  • Medica Insure Silver $0 Copay PCP Visits - EPO
  • Medica Insure Silver Share - EPO
  • Medica Insure Silver Standard - EPO
  • Bronze Classic 4700 - EPO
  • Bronze Classic 4700 | MercyOne - EPO
  • Bronze Classic Standard - EPO
  • Bronze Classic Standard | MercyOne - EPO
  • Bronze Elite + PCP Saver Plus - EPO
  • Bronze Elite + PCP Saver Plus | MercyOne - EPO
  • Bronze Simple Breathe Easy with Enhanced COPD Benefits | MercyOne - EPO
  • Bronze Simple Chronic Care CKM | MercyOne - EPO
  • Bronze Simple Diabetes | MercyOne - EPO
  • Gold Classic Standard - EPO
  • UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
  • UHC Bronze Essential (No Referrals) - EPO
  • UHC Bronze Standard (No Referrals) - EPO
  • UHC Bronze Standard+ (Dental + Vision, No Referrals) - EPO
  • UHC Gold Advantage ($0 Virtual Urgent Care, No Referrals) - EPO
  • UHC Gold Advantage+ ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
  • UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $8 Tier 2 Rx, No Referrals) - EPO
  • UHC Gold Standard (No Referrals) - EPO
  • UHC Silver Advantage ($0 Virtual Urgent Care, No Referrals) - EPO
  • UHC Silver Advantage+ ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

DR. TERI S FORMANEK M.D.

Authorized Official Title
PRESIDENT
Authorized Official Phone
(515) 327-1555

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
F252394OTHER (01)IACIGNA
61026OTHER (01)IAWELLMARK BCBS
F252394OTHER (01)IACARPENTERS DISTRICT COUN
0610352MEDICAID (05)IA 
61026OTHER (01)IAFEDERAL EMPLOYEES HEALTH
F252394OTHER (01)IAMIDLANDS AETNA
61026OTHER (01)IAWELLMARK HEALTH PLANS IA

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Aspiration and/or injection of fluid from large joint

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

This service was performed 53 times for 38 patients

Aspiration and/or injection of fluid large joint using ultrasound guidance

This procedure involves using ultrasound technology to accurately locate a large joint, usually the knee or shoulder. A needle is then inserted to either extract fluid (aspiration) or inject medication. The ultrasound helps ensure precision and safety.

This service was performed 15 times for 12 patients

Biopsy or removal of deep lymph nodes of underarm

A biopsy or removal of deep underarm lymph nodes is a procedure where a small sample of lymph node tissue is taken for testing. This helps in diagnosing or ruling out conditions like infections or cancers. It involves a small incision and is typically done under local or general anesthesia.

This service was performed 13 times for 13 patients

Complete exam of nose and sinuses using an endoscope

This procedure involves inserting a thin tube with a light (endoscope) into the nose to examine the nasal passages and sinuses. It helps identify any abnormalities or issues. The process is safe, usually painless, and provides valuable information for your care.

This service was performed 11 times for 11 patients

Complete laser vaporization of prostate including control of bleeding using an endoscope

This procedure involves using a special light instrument to carefully remove tissue from a gland located in the lower body. This helps improve the flow of body fluids. The process is done through a tube-like device and also controls any bleeding.

This service was performed 53 times for 52 patients

Correction of toe joint deformity

Correction of toe joint deformity is a procedure to fix misshapen toe joints. This can involve realigning the bones, removing bone or tissue, or implanting devices to improve joint function. It can help reduce pain and improve mobility.

This service was performed 19 times for 13 patients

Crushing of stone of ureter with insertion of stent using an endoscope

This procedure involves using a thin, flexible tube (endoscope) to locate and break down kidney stones in the ureter. After this, a small tube (stent) is inserted to help maintain an open pathway for urine to flow.

This service was performed 52 times for 45 patients

Destruction and/or removal of growth of bladder and urethra using an endoscope, 2.0-5.0 cm

This procedure involves using a thin, flexible tool called an endoscope to examine and remove a growth in your bladder and urethra. The growth size ranges from 2.0-5.0 cm. This is done to ensure your urinary system functions properly.

This service was performed 16 times for 15 patients

Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint

This procedure involves using imaging guidance to accurately target and destroy nerves in the lower or sacral spinal facet joint. It's done to relieve chronic back pain. The process is safe and usually effective.

This service was performed 204 times for 116 patients

Destruction of surface soft tissue of nasal passages

This procedure involves removing or destroying soft tissue in the nasal passages. It's often performed to improve breathing, reduce snoring, or treat conditions like nasal polyps. The process is usually done under local or general anesthesia.

This service was performed 22 times for 22 patients

Destruction of upper or middle spinal facet joint nerves using imaging guidance, single facet joint

This procedure involves the use of imaging technology to guide a needle to the nerves of a single facet joint in the upper or middle spine. The nerves are then treated to alleviate pain and improve mobility.

This service was performed 18 times for 14 patients

Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level

This procedure involves injecting a mix of numbing and anti-inflammatory medication into a specific nerve root in the lower back. It helps manage pain and reduce inflammation. The process is guided by imaging technology for precision.

This service was performed 161 times for 133 patients

Injection of lower or sacral spine facet joint using imaging guidance, single level

This procedure involves injecting medication into the facet joint in your lower back or sacral spine. It's done under imaging guidance to ensure accuracy. The aim is to alleviate pain and inflammation. It's a safe, often effective method for managing spinal discomfort.

This service was performed 245 times for 125 patients

Injection of substance into lower spine canal using imaging guidance

This procedure involves injecting a substance into your lower spine canal, guided by real-time images. It's done to diagnose or treat various conditions. You may feel slight discomfort, but it's generally safe and can provide valuable information for your treatment plan.

This service was performed 153 times for 125 patients

Injection of substance into middle or upper spine canal using imaging guidance

This procedure involves injecting a substance into your middle or upper spine canal. It's performed under imaging guidance to ensure accuracy. The substance can help diagnose or treat various conditions, providing relief from symptoms.

This service was performed 57 times for 49 patients

Injection of trigger points, 1-2 muscles

Trigger point injection is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. 1-2 muscles are typically treated in one session. The procedure involves injecting medications into these points to alleviate pain.

This service was performed 28 times for 26 patients

Injection of trigger points, 3 or more muscles

Trigger point injection therapy involves injecting medication into specific areas of your muscles, known as trigger points. These are areas that produce pain and discomfort. If you have three or more muscles affected, each will be treated individually.

This service was performed 33 times for 29 patients

Injection of upper or middle spine facet joint using imaging guidance, single level

This procedure involves injecting medication into a joint in your upper or middle spine. It's performed under imaging guidance for precision. The aim is to reduce inflammation and pain. It's a single-level process, meaning one joint is treated at a time.

This service was performed 25 times for 14 patients

Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography

This procedure involves injecting medicine into the sacroiliac joint, located in the lower back. The aim is to reduce inflammation and pain. Anesthetic is used for immediate pain relief, while a steroid helps decrease inflammation over time. Arthrography, a type of imaging, may be used for precision.

This service was performed 142 times for 77 patients

Injection, bupivacaine liposome, 1 mg

Bupivacaine liposome is a local anesthetic used to numb a specific area of the body and reduce pain or discomfort associated with surgical procedures. The 1 mg dosage is injected by a healthcare professional at the required site.

This service was performed 5,187 times for 36 patients

Insertion of peripheral or gastric neurostimulator generator

The insertion of a peripheral or gastric neurostimulator generator is a procedure that helps manage chronic pain or gastric conditions. A small device is surgically placed under the skin, which sends mild electrical signals to the nerves involved.

This service was performed 11 times for 11 patients

Insertion of stent in ureter using an endoscope

This procedure involves placing a small, flexible tube (stent) in your body's drainage system to help urine flow from the kidneys to the bladder. An endoscope, a thin tube with a light and camera, is used for precise placement.

This service was performed 51 times for 42 patients

Obtaining ear cartilage for grafting

Obtaining ear cartilage for grafting involves a minor surgical procedure. A small piece of cartilage is taken from your ear, usually from a hidden area. This cartilage can then be used to repair or reconstruct other parts of the body. The procedure is generally safe with minimal discomfort.

This service was performed 13 times for 13 patients

Removal of excessive skin and fat of upper eyelid

This procedure, also known as upper eyelid surgery, is performed to remove excess skin and fat from the upper eyelid. It can help improve vision if heavy eyelids hinder it, and can also enhance the appearance of the eyes. It's a common, safe procedure.

This service was performed 25 times for 23 patients

Removal of extensive shoulder joint tissue using an endoscope

This procedure, known as arthroscopic debridement, involves using a small camera (endoscope) to view your shoulder joint. Damaged or unwanted tissue is then carefully removed. This minimally invasive technique aims to reduce pain and improve joint mobility.

This service was performed 16 times for 16 patients

Removal of nasal air passage under lining tissue

This procedure, often done to improve breathing or address sinus issues, involves the removal of tissue from the lining of the nasal air passage. It's performed under anesthesia and recovery time varies based on individual health status.

This service was performed 13 times for 13 patients

Removal of nasal sinus tissue using an endoscope

This procedure, known as endoscopic sinus surgery, involves using a thin, flexible tube with a light and camera to view and remove problematic nasal sinus tissue. It helps to alleviate sinus issues and improve breathing.

This service was performed 26 times for 25 patients

Repair of brow paralysis

Repair of brow paralysis is a procedure aimed to restore function and symmetry to the face. This is achieved by adjusting muscles and nerves in the brow area. It can help improve the appearance and movement of the forehead and eyebrows, enhancing overall facial expressions.

This service was performed 26 times for 24 patients

Repair of shoulder rotator cuff using an endoscope

This procedure, known as arthroscopic rotator cuff repair, helps fix tears in the shoulder's rotator cuff. An endoscope, a small camera, is used to view the shoulder inside. Using small tools, the surgeon repairs the torn tissue. This minimally invasive approach often leads to a quicker recovery.

This service was performed 15 times for 14 patients

Replacement of knee joint, both sides of knee

A bilateral knee joint replacement is a procedure where the damaged parts of both your knee joints are replaced with artificial parts. It aims to relieve pain and improve mobility. The process involves a surgical operation under anesthesia.

This service was performed 21 times for 19 patients

Reshaping of nasal cartilage

Reshaping of nasal cartilage, also known as rhinoplasty, is a surgical procedure to modify the structure of the nose for aesthetic or functional purposes. It involves adjusting the cartilage and bone in the nose to achieve the desired shape or to improve breathing.

This service was performed 19 times for 19 patients

Shock wave crushing of kidney stones

Shock wave crushing of kidney stones, also known as Extracorporeal Shock Wave Lithotripsy (ESWL), is a non-invasive treatment. It involves the use of sound waves to break down kidney stones into small pieces that can easily pass through your urinary tract.

This service was performed 56 times for 47 patients

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
16D1058574
Facility Type
Ambulatory Surgery Center
Certificate Effective Date
September 08, 2024
Certificate Expiration Date
September 07, 2026
Laboratory Director
TERI S. FORMANEK
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to West Lakes Surgery Center Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1104933696, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 64. The final step is to find the difference between that total and the next multiple of ten (70 - 64 = 6).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
1
Unchanged
Pos 3
0
Doubled → 0
Pos 4
4
Unchanged
Pos 5
9
Doubled → 18 → 1 + 8
Pos 6
3
Unchanged
Pos 7
3
Doubled → 6
Pos 8
6
Unchanged
Pos 9
9
Doubled → 18 → 1 + 8
Check
6
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 0 → 0 9 → 18 → 9 3 → 6 9 → 18 → 9

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 1 + 0 + 4 + 1 + 8 + 3 + 6 + 6 + 1 + 8 + 24 = 64

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 64 is 70. The difference is the calculated check digit.

70 - 64 = 6
This NPI is valid
The calculated check digit is 6, which matches the last digit of 1104933696.

Other Providers at the Same Location


The following 20 providers are registered at the same or a nearby location.

Orthopaedic Surgery
12499 UNIVERSITY AVE, SUITE 210
DES MOINES, IA 50325
Audiologist
12499 UNIVERSITY AVE, SUITE 200
CLIVE, IA 50325
Orthopaedic Surgery (Sports Medicine)
12499 UNIVERSITY AVE, SUITE 210
DES MOINES, IA 50325
Orthopaedic Surgery
12499 UNIVERSITY AVE, SUITE 210
DES MOINES, IA 50325
Podiatrist (Foot & Ankle Surgery)
12499 UNIVERSITY AVE, SUITE 210
DES MOINES, IA 50325
Orthopaedic Surgery
12499 UNIVERSITY AVE, STE. 210
CLIVE, IA 50325
Physical Medicine & Rehabilitation
12499 UNIVERSITY AVE, SUITE 210
CLIVE, IA 50325
Orthopaedic Surgery
12499 UNIVERSITY AVE, SUITE 210
CLIVE, IA 50325
Surgery
12499 UNIVERSITY AVE, STE. 210
CLIVE, IA 50325
Podiatrist
12499 UNIVERSITY AVE, SUITE 210
CLIVE, IA 50325
Orthopaedic Surgery
12499 UNIVERSITY AVE, SUITE 210
CLIVE, IA 50325
Orthopaedic Surgery (Adult Reconstructive Orthopaedic Surgery)
12499 UNIVERSITY AVE
CLIVE, IA 50325
Audiologist
12499 UNIVERSITY AVE, STE 200
CLIVE, IA 50325
Otolaryngology (Otology & Neurotology)
12499 UNIVERSITY AVE, STE 200
CLIVE, IA 50325
Nurse Practitioner (Family)
12499 UNIVERSITY AVE, STE 200
CLIVE, IA 50325
Audiologist
12499 UNIVERSITY AVE, STE 200
CLIVE, IA 50325
Specialist
12499 UNIVERSITY AVE, SUITE 200
CLIVE, IA 50325
Nurse Practitioner
12499 UNIVERSITY AVE
CLIVE, IA 50325
Nurse Practitioner
12499 UNIVERSITY AVE
CLIVE, IA 50325
Hearing Instrument Specialist
12499 UNIVERSITY AVE
CLIVE, IA 50325

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1104933696, enumerated as an "organization" on August 23, 2006.

The provider is located at 12499 UNIVERSITY AVE SUITE 100 CLIVE, IA 50325 and the phone number is (515) 974-5050.

Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.

The provider might be accepting Accepts: Medica, Oscar Insurance Company, UnitedHealthcare,. Please consult your insurance carrier or call the provider to verify.