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BLACK RIVER AMBULATORY SURGERY CENTER, LLC
NPI 1770149304
Clinic/Center - Ambulatory Surgical in Poplar Bluff, MO

Active since May 20, 2019CLIA 26D2169776 · Waiver
219 PHYSICIANS PARK, POPLAR BLUFF, MO 63901(573) 609-2444 Get Directions Write a Review

NPPES record last updated: May 20, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Black River Ambulatory Surgery Center, Llc NPPES

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

BLACK RIVER AMBULATORY SURGERY CENTER, LLC (NPI 1770149304) is a healthcare organization registered as an ambulatory surgical in Poplar Bluff, Missouri and active in the NPI registry since May 2019. The organization holds a CLIA Waiver certificate valid through July 25, 2027 and lists David C Prather, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1770149304
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameBLACK RIVER AMBULATORY SURGERY CENTER, LLC
Location Address219 PHYSICIANS PARKPoplar Bluff, MO 63901-3956
Mailing Address219 Physicians ParkPoplar Bluff, MO 63901-3956
Phone(573) 609-2444
Organization SubpartNo
Authorized OfficialDavid C PratherChief Financial Officer · (573) 331-5129
Enumeration DateMay 20, 2019
✔ NPI 1770149304 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X
219 PHYSICIANS PARK, Poplar Bluff, MO 63901
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, UnitedHealthcare.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 26D2169776

Black River Ambulatory Surgery Center, LLC · Poplar Bluff, MO
Active · expires Jul 25, 2027
CLIA Number26D2169776
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateJuly 26, 2025
Certificate Expiration DateJuly 25, 2027
Laboratory DirectorMatthew J. Riffle
Laboratory Phone(573) 727-9080
Laboratory LocationBlack River Ambulatory Surgery Center, LLC219 Physicians Park Drive, Poplar Bluff, MO 63901
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 10

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.

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.
340 services210 patients
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239
This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.
136 services136 patients
Biopsy of large bowel using a flexible endoscope 45380
A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.
132 services132 patients
Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385
This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.
117 services116 patients
Complex removal of cataract with insertion of prosthetic lens 66982
This procedure involves removing a cloudy lens (cataract) from your eye and replacing it with a clear, artificial lens. It helps restore vision that has been affected by the cataract. The operation is usually done under local anesthesia.
66 services48 patients
Colorectal cancer screening; colonoscopy on individual at high risk G0105
Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.
43 services43 patients

Other Providers at the Same Location NPPES 4

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

GUARDIAN ANESTHESIA ASSOCIATES LLC
Nurse Anesthetist, Certified Registered
219 PHYSICIANS PARK
POPLAR BLUFF, MO 63901
Butler County (573) 686-5550
DONALD FOUST CRNA
Nurse Anesthetist, Certified Registered
219 PHYSICIANS PARK
POPLAR BLUFF, MO 63901
Butler County (573) 686-5550
MID-LAND ANESTHESIA ASSOCIATES
Nurse Anesthetist, Certified Registered
219 PHYSICIANS PARK
POPLAR BLUFF, MO 63901
Butler County (573) 686-5550
JOHN BOLLENBACHER CRNA
Nurse Anesthetist, Certified Registered
219 PHYSICIANS PARK
POPLAR BLUFF, MO 63901
Butler County (573) 686-5550

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 Black River Ambulatory Surgery Center, LLC's NPI number?

The NPI number for Black River Ambulatory Surgery Center, LLC is 1770149304. It was assigned to this organization in the NPPES registry on May 20, 2019.

Where is Black River Ambulatory Surgery Center, LLC located?

Black River Ambulatory Surgery Center, LLC is located at 219 Physicians Park, Poplar Bluff, MO 63901. The listed phone number is (573) 609-2444.

What is Black River Ambulatory Surgery Center, LLC's specialty?

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

Does Black River Ambulatory Surgery Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D2169776) is associated with this NPI, valid through July 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Black River Ambulatory Surgery Center, LLC accept?

Health plans from Anthem Blue Cross and Blue Shield and UnitedHealthcare list Black River Ambulatory 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 Black River Ambulatory Surgery Center, LLC was last updated on May 20, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.