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GOOD SAMARITAN SURGERY CENTER
NPI 1285980151
Clinic/Center - Ambulatory Surgical in Mount Vernon, IL

Active since July 30, 2012CLIA 14D2047582 · Waiver
2 GOOD SAMARITAN WAY, STE 200, MOUNT VERNON, IL 62864(618) 899-5703(618) 899-5704 Get Directions Write a Review

NPPES record last updated: January 8, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 8, 2025, Apr 23, 2024, May 10, 2023 (3 updates tracked since 2023).

About Good Samaritan Surgery Center NPPES

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

GOOD SAMARITAN SURGERY CENTER (NPI 1285980151) is a healthcare organization registered as an ambulatory surgical in Mount Vernon, Illinois and active in the NPI registry since July 2012. The organization holds a CLIA Waiver certificate valid through September 25, 2026 and lists Joon Ahn, Authorized Official - Owner, as its authorized official.

NPPES Registry Identity

NPI1285980151
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NamePHYSICIANS SURGERY CENTER AT GOOD SAMARITAN, LLC
Location Address2 GOOD SAMARITAN WAY, STE 200Mount Vernon, IL 62864-2476
Mailing Address2 Good Samaritan Way, Ste 200Mount Vernon, IL 62864-2476 · (618) 899-5703 · Fax (618) 899-5704
Phone(618) 899-5703
Fax(618) 899-5704
Organization SubpartNo
Authorized OfficialJoon AhnAuthorized Official - Owner · (618) 899-5703
Enumeration DateJuly 30, 2012
Last NPPES UpdateJanuary 8, 20253 updates tracked since enumeration
NPPES CertifiedJanuary 8, 2025
✔ NPI 1285980151 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 IL · 7003172
2 GOOD SAMARITAN WAY, Mount Vernon, IL 62864
Open in Google Maps ↗

Other Names 1

Doing Business AsGood Samaritan Surgery Center

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 14D2047582

Physicians Surgery Center At Good Samaritan L L C · Mount Vernon, IL
Active · expires Sep 25, 2026
CLIA Number14D2047582
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateSeptember 26, 2024
Certificate Expiration DateSeptember 25, 2026
Laboratory DirectorSteve Roodman M D
Laboratory Phone(618) 899-5703
Laboratory LocationPhysicians Surgery Center At Good Samaritan L L C2 Good Samaritan Way, Ste 200, Mount Vernon, IL 62864
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 8

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, onabotulinumtoxina, 1 unit J0585
Onabotulinumtoxina, also known as Botox, is a medication injected into muscles. It's used to treat various conditions by blocking nerve activity in the muscles, causing a temporary reduction in muscle activity. The units refer to the dosage.
3,303 services21 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.
220 services127 patients
Release of wrist ligament using an endoscope 29848
This procedure involves using a small camera, called an endoscope, to view and treat a tight wrist ligament. The endoscope is inserted through a tiny incision, reducing recovery time and scarring. It helps to relieve pain and improve wrist function.
72 services62 patients
Repair of shoulder rotator cuff using an endoscope 29827
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.
33 services32 patients
Exam with injections of chemical for destruction of bladder using an endoscope 52287
This procedure involves the use of a thin, flexible tube with a light (endoscope) for internal examination. A chemical is then injected to help eliminate specific issues in the bladder. It's a standard and safe process.
25 services22 patients
Crushing of stone of ureter with insertion of stent using an endoscope 52356
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.
19 services16 patients

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS, LLC
Psychiatry & Neurology (Sleep Medicine)
2 GOOD SAMARITAN WAY, SUITE 400
MOUNT VERNON, IL 62864
Jefferson County (618) 241-1869
JONATHAN L SORENSON CRNA
Nurse Anesthetist, Certified Registered
2 GOOD SAMARITAN WAY, SUITE 205
MOUNT VERNON, IL 62864
Jefferson County (618) 241-1108
DANIEL HOFFMAN MD
Internal Medicine
2 GOOD SAMARITAN WAY, SUITE 420
MOUNT VERNON, IL 62864
Jefferson County (618) 899-4000
DR. PRATEEK SRINET M.D.
Otolaryngology
2 GOOD SAMARITAN WAY, SUITE 420
MOUNT VERNON, IL 62864
Jefferson County (618) 899-4000
MR. STEVEN J CLARK MD
Surgery (Plastic and Reconstructive Surgery)
2 GOOD SAMARITAN WAY, SUITE 235
MOUNT VERNON, IL 62864
Jefferson County (618) 899-3980
MRS. DEBBIE JANE BENDERSKY RPH
Pharmacist
2 GOOD SAMARITAN WAY, SUITE 120
MOUNT VERNON, IL 62864
Jefferson County (618) 899-4999
DR. ISMAT CHEEMA DO
Internal Medicine
2 GOOD SAMARITAN WAY
MOUNT VERNON, IL 62864
Jefferson County (618) 899-3607
MARY K MCGARVEY COTA
Occupational Therapy Assistant
2 GOOD SAMARITAN WAY
MOUNT VERNON, IL 62864
Jefferson County (618) 899-2400

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 Physicians Surgery Center At Good Samaritan, LLC's NPI number?

The NPI number for Physicians Surgery Center At Good Samaritan, LLC is 1285980151. It was assigned to this organization in the NPPES registry on July 30, 2012. The provider is doing business as Good Samaritan Surgery Center.

Where is Physicians Surgery Center At Good Samaritan, LLC located?

Physicians Surgery Center At Good Samaritan, LLC is located at 2 Good Samaritan Way Ste 200, Mount Vernon, IL 62864. The listed phone number is (618) 899-5703.

What is Physicians Surgery Center At Good Samaritan, LLC's specialty?

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

Does Physicians Surgery Center At Good Samaritan, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2047582) is associated with this NPI, valid through September 25, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Physicians Surgery Center At Good Samaritan, LLC was last updated on January 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months 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.