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SOURCE SURGERY CENTER LLC
NPI 1558802249
Clinic/Center - Ambulatory Surgical in Santa Monica, CA

Active since March 14, 2017CLIA 05D2145701 · Waiver
2801 WILSHIRE BLVD, SANTA MONICA, CA 90403(310) 574-2777(310) 315-4968 Get Directions Write a Review

NPPES record last updated: January 21, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 21, 2020, Mar 15, 2017 (2 updates tracked since 2017).

About Source Surgery Center Llc NPPES

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

SOURCE SURGERY CENTER LLC (NPI 1558802249) is a healthcare organization registered as an ambulatory surgical in Santa Monica, California and active in the NPI registry since March 2017. The organization holds a CLIA Waiver certificate valid through March 12, 2028 and lists Timothy T Davis, Owner, as its authorized official.

NPPES Registry Identity

NPI1558802249
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameSOURCE SURGERY CENTER LLC
Location Address2801 WILSHIRE BLVDSanta Monica, CA 90403-4801
Mailing Address1112 Montana Ave, Suite 900Santa Monica, CA 90403-1652 · (310) 574-2777 · Fax (310) 315-4968
Phone(310) 574-2777
Fax(310) 315-4968
Organization SubpartNo
Authorized OfficialTimothy T DavisOwner · (310) 574-2777
Enumeration DateMarch 14, 2017
Last NPPES UpdateJanuary 21, 20202 updates tracked since enumeration
✔ NPI 1558802249 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
2801 WILSHIRE BLVD, Santa Monica, CA 90403
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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 05D2145701

Source Surgery Center LLC · Santa Monica, CA
Active · expires Mar 12, 2028
CLIA Number05D2145701
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateMarch 13, 2026
Certificate Expiration DateMarch 12, 2028
Laboratory DirectorTimothy T. Davis
Laboratory Phone(310) 574-2777
Laboratory LocationSource Surgery Center LLC2801 Wilshire Blvd, Santa Monica, CA 90403
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 of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level 64483
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.
246 services142 patients
Injection of lower or sacral spine facet joint using imaging guidance, single level 64493
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.
112 services45 patients
Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography G0260
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.
84 services58 patients
Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint 64635
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.
56 services27 patients
Injection of upper or middle spine facet joint using imaging guidance, single level 64490
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.
43 services19 patients
Injection of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance, single level 64479
This procedure involves injecting anesthetic or steroid medication into a specific nerve root in the upper or middle spine. It's performed using imaging technology for precise placement. The aim is to reduce inflammation and alleviate pain.
33 services22 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 Source Surgery Center LLC's NPI number?

The NPI number for Source Surgery Center LLC is 1558802249. It was assigned to this organization in the NPPES registry on March 14, 2017.

Where is Source Surgery Center LLC located?

Source Surgery Center LLC is located at 2801 Wilshire Blvd, Santa Monica, CA 90403. The listed phone number is (310) 574-2777.

What is Source Surgery Center LLC's specialty?

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

Does Source Surgery Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2145701) is associated with this NPI, valid through March 12, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Source Surgery Center LLC was last updated on January 21, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.