EXECUTIVE AMBULATORY SURGICAL CENTER, LLC
NPI 1386056356
Clinic/Center - Ambulatory Surgical in Dearborn, MI
About Executive Ambulatory Surgical Center, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EXECUTIVE AMBULATORY SURGICAL CENTER, LLC (NPI 1386056356) is a healthcare organization registered as an ambulatory surgical in Dearborn, Michigan and active in the NPI registry since May 2014. The organization holds a CLIA Waiver certificate valid through August 27, 2028 and lists Samer Suleiman, Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Accepted 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)
Executive Ambulatory Surgical Center, 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 Executive Ambulatory Surgical Center, LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 23D2083095
Executive Ambulatory Surgical Center, LLC · Dearborn, MIAreas of Expertise CMS Part B claims
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.
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 Executive Ambulatory Surgical Center, LLC's NPI number?
The NPI number for Executive Ambulatory Surgical Center, LLC is 1386056356. It was assigned to this organization in the NPPES registry on May 27, 2014.
Where is Executive Ambulatory Surgical Center, LLC located?
Executive Ambulatory Surgical Center, LLC is located at 17000 Executive Plaza Dr Suite 301, Dearborn, MI 48126. The listed phone number is (313) 408-6613.
What is Executive Ambulatory Surgical Center, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.
Is Executive Ambulatory Surgical Center, LLC enrolled in Medicare?
Yes. Executive Ambulatory Surgical Center, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Executive Ambulatory Surgical Center, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Anesthesiology) reassigns their Medicare billing to Executive Ambulatory Surgical Center, 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 Executive Ambulatory Surgical Center, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 23D2083095) is associated with this NPI, valid through August 27, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Executive Ambulatory Surgical Center, LLC accept?
Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 2 other insurers list Executive Ambulatory Surgical Center, 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 Executive Ambulatory Surgical Center, LLC was last updated on November 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Executive Ambulatory Surgical Center, Llc · NPI 1386056356
Ambulatory Surgical organization in Dearborn, Michigan. Organization record, active in the CMS NPPES registry since May 27, 2014.
## Identity
- **NPI:** 1386056356 (Entity type: Organization)
- **Enumerated:** May 27, 2014
- **Primary specialty:** Clinic/Center - Ambulatory Surgical · taxonomy 261QA1903X
- **Organization subpart:** No
- **Authorized official:** Samer Suleiman, MANAGER
## Practice location
- **Address:** 17000 EXECUTIVE PLAZA DR, SUITE 301, Dearborn, MI 48126-2793
- **Phone:** (313) 408-6613
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Anesthesiology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 20, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1386056356) · Data from the CMS NPPES public registry.