INDIAN LAKE SURGERY CENTER
NPI 1558785683
Clinic/Center - Ambulatory Surgical in Hendersonville, TN
NPI Status: Active since February 10, 2014
Contact Information
127 SAUNDERSVILLE RD.
SUITE A
HENDERSONVILLE, TN
ZIP 37075
Phone: (615) 265-8038
Fax: (615) 265-8546
- Organization
- Clinic/Center
- Ambulatory Surgical
- Accepts Insurance
- CLIA Number: 44D2073663
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 02-20-2028
About INDIAN LAKE SURGERY CENTER
This page provides the complete NPI Profile along with additional information for Indian Lake Surgery Center, a provider established in Hendersonville, Tennessee operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1558785683 assigned on February 2014. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 12 years ago. The provider's is doing business as Indian Lake Surgery Center. The authorized official of this NPI record is Dr. Thomas Gautsch M.d. (Ceo)
- NPI
- 1558785683
- Provider Legal Name
- SOUTHERN SPORTS SURGICAL, LLC.
- Other Organization Name
- INDIAN LAKE SURGERY CENTER
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 127 SAUNDERSVILLE RD. SUITE A HENDERSONVILLE, TN 37075
- Location Phone
- (615) 265-8038
- Location Fax
- (615) 265-8546
- Mailing Address
- 127 SAUNDERSVILLE RD. SUITE A HENDERSONVILLE, TN 37075
- Mailing Phone
- (615) 265-8038
- Mailing Fax
- (615) 265-8546
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-10-2014
- Last Update Date
- 08-19-2014
- Code Navigator
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
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health� - EPO
- BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � - EPO
- BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health� - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
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.
Injection, bupivacaine liposome, 1 mg
Release of tendon connecting biceps muscle and shoulder using an endoscope
Removal of both knee cartilages using an endoscope
Removal of knee cartilage using an endoscope
Repair of shoulder rotator cuff using an endoscope
Replacement of knee joint, both sides of knee
Replacement of thigh bone and hip joint with prosthesis
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 29,260 times for 100 patientsThis procedure involves using a small camera, known as an endoscope, to view and release the tendon connecting your biceps muscle and shoulder. It can help reduce pain and improve mobility. The procedure is minimally invasive, promoting quicker recovery.
This service was performed 11 times for 11 patientsThis procedure, also known as bilateral knee arthroscopy, involves using a small camera (endoscope) to view and remove damaged cartilage from both knees. It's a minimally invasive surgery aimed at relieving pain and improving mobility.
This service was performed 12 times for 11 patientsThis procedure, known as arthroscopic knee surgery, involves using a small camera (endoscope) to view the inside of your knee. Small instruments are used to remove damaged cartilage. This can help alleviate pain and improve knee function.
This service was performed 11 times for 11 patientsThis 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 16 times for 16 patientsA 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 120 times for 109 patientsThis procedure, known as hip arthroplasty, involves replacing your damaged thigh bone and hip joint with artificial parts, called a prosthesis. It helps relieve pain, improve mobility, and enhance your quality of life.
This service was performed 11 times for 11 patientsCLIA 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
- 44D2073663
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- February 21, 2026
- Certificate Expiration Date
- February 20, 2028
- Laboratory Director
- DR. PAUL GRUTTER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Indian Lake Surgery Center 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 1558785683, we treat the final digit (3) 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 67. The final step is to find the difference between that total and the next multiple of ten (70 - 67 = 3).
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.
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.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 67 is 70. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1558785683, enumerated as an "organization" on February 10, 2014.
The provider is located at 127 SAUNDERSVILLE RD. SUITE A HENDERSONVILLE, TN 37075 and the phone number is (615) 265-8038.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
The provider might be accepting Accepts: BlueCross BlueShield of Tennessee. Please consult your insurance carrier or call the provider to verify.