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PROVO SURGERY CENTER, LLC
NPI 1639853757
Clinic/Center - Ambulatory Surgical in Provo, UT

Active since June 09, 2023CLIA 46D2284821 · Waiver

NPPES record last updated: November 25, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 25, 2025, Aug 11, 2025, Jun 9, 2023 (3 updates tracked since 2023).

About Provo Surgery Center, Llc NPPES

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

PROVO SURGERY CENTER, LLC (NPI 1639853757), doing business as Intermountain Health Surgery Center - Utah Valley, is a healthcare organization registered as an ambulatory surgical in Provo, Utah and active in the NPI registry since June 2023. The organization holds a CLIA Waiver certificate valid through June 28, 2027 and lists Adam Bergeson, Board Member, as its authorized official.

NPPES Registry Identity

NPI1639853757
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NamePROVO SURGERY CENTER, LLC
Location Address1157 N 300 WProvo, UT 84604-6124
Mailing Address1157 N 300 WProvo, UT 84604-6124
Phone(385) 283-1906
Organization SubpartNo
Authorized OfficialAdam BergesonBoard Member · (801) 660-7980
Enumeration DateJune 9, 2023
Last NPPES UpdateNovember 25, 20253 updates tracked since enumeration
NPPES CertifiedNovember 25, 2025
✔ NPI 1639853757 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
1157 N 300 W, Provo, UT 84604
Open in Google Maps ↗

Other Names 2

Doing Business AsIntermountain Health Surgery Center - Utah Valley
Doing Business AsIntermountain Surgery Center - Utah Valley

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare, Select Health.Insurance ›

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 46D2284821

Provo Surgery Center, LLC · Provo, UT
Active · expires Jun 28, 2027
CLIA Number46D2284821
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateJune 29, 2025
Certificate Expiration DateJune 28, 2027
Laboratory DirectorMatthew Wagaman
Laboratory Phone(801) 361-4541
Laboratory LocationProvo Surgery Center, LLC1157 N 300 W, Provo, UT 84604
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 9

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, bupivacaine liposome, 1 mg C9290
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.
6,391 services51 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.
34 services27 patients
Replacement of knee joint, both sides of knee 27447
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.
30 services26 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.
30 services24 patients
Imaging of urinary tract following injection of a contrast agent 74420
This procedure involves injecting a contrast agent into your body to help highlight the urinary tract during imaging. The contrast agent makes your urinary tract more visible on the images, providing detailed information about its structure and function. This can help in diagnosing any potential issues.
30 services30 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.
21 services20 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.

TROY W BITTERS PA
Physician Assistant
1157 N 300 W, #201
PROVO, UT 84604
Utah County (801) 357-8898
JEFFREY R SMITH MD
Orthopaedic Surgery
1157 N 300 W, SUITE 201
PROVO, UT 84604
Utah County (801) 357-8898
WAYNE W MORTENSEN MD
Orthopaedic Surgery
1157 N 300 W, #201
PROVO, UT 84604
Utah County (801) 357-8898
IHC HEALTH SERVICES INC
Orthopaedic Surgery
1157 N 300 W, #201
PROVO, UT 84604
Utah County (801) 357-1200
DR. MATTHEW CRAIG EVANS M.D.
Family Medicine (Sports Medicine)
1157 N 300 W, #201
PROVO, UT 84604
Utah County (801) 581-2000
DR. MATTHEW COLLIN GREEN M.D., J.D.
Orthopaedic Surgery
1157 N 300 W, SUTIE 201
PROVO, UT 84604
Utah County (801) 357-1200
MATTHEW K. MONEY MD
Otolaryngology
1157 N 300 W, SUITE 301
PROVO, UT 84604
Utah County (801) 357-4460
DR. STEPHEN PETERS PSYD
Psychiatry & Neurology (Clinical Neurophysiology)
1157 N 300 W
PROVO, UT 84604
Utah County (801) 357-1200

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 Provo Surgery Center, LLC's NPI number?

The NPI number for Provo Surgery Center, LLC is 1639853757. It was assigned to this organization in the NPPES registry on June 9, 2023.

Where is Provo Surgery Center, LLC located?

Provo Surgery Center, LLC is located at 1157 N 300 W, Provo, UT 84604. The listed phone number is (385) 283-1906.

What is Provo Surgery Center, LLC's specialty?

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

Does Provo Surgery Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 46D2284821) is associated with this NPI, valid through June 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Provo Surgery Center, LLC accept?

Health plans from Molina Healthcare and Select Health list Provo Surgery 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 Provo Surgery Center, LLC was last updated on November 25, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.