4TH STREET LASER & SURGERY CENTER INC
NPI 1902964174
Clinic/Center - Ambulatory Surgical in Santa Rosa, CA

NPI Status: Active since December 04, 2006

Contact Information

1720 4TH ST
SANTA ROSA, CA
ZIP 95404
Phone: (707) 546-8100
Fax: (707) 544-6438

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  • Organization
  • Clinic/Center
  • Ambulatory Surgical
  • CLIA Number: 05D1008140
  • CLIA Cert. Type: Ambulatory Surgery Center
  • CLIA Exp. Date: 01-09-2027

About 4TH STREET LASER & SURGERY CENTER INC

This page provides the complete NPI Profile along with additional information for 4th Street Laser & Surgery Center Inc, a provider established in Santa Rosa, California operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1902964174 assigned on December 2006. The practitioner's primary taxonomy code is 261QA1903X with license number 110000344 (CA). The provider is registered as an organization and their NPI record was last updated 13 years ago. The authorized official of this NPI record is Ms. Elayne Clark Rn Casc (Administrator)

NPI
1902964174
Provider Name
4TH STREET LASER & SURGERY CENTER INC
Entity Type
Organization
Location Address
1720 4TH ST SANTA ROSA, CA 95404
Location Phone
(707) 546-8100
Location Fax
(707) 544-6438
Mailing Address
1720 4TH ST SANTA ROSA, CA 95404
Mailing Phone
(707) 546-8100
Mailing Fax
(707) 544-6438
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
12-04-2006
Last Update Date
01-17-2013
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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
License No.
110000344
License State
CA

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MS. ELAYNE CLARK RN CASC

Authorized Official Title
ADMINISTRATOR
Authorized Official Phone
(707) 546-8100

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
110000344OTHER (01)CASTATE OF CA LICENSE
SUR01428GMEDICAID (05)CA 
ZZZ15550ZMEDICARE ID-TYPE UNSPECIFIED (04)CAMEDICARE PROVIDER ID#

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.

Complex removal of cataract with insertion of prosthetic lens

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.

This service was performed 18 times for 17 patients

Extracapsular removal of cataract with insertion of artificial lens and insertion of drainage device in front chamber of eye

This is a two-part eye procedure. First, a cloudy lens (cataract) is removed from its outer layer and replaced with an artificial lens to improve vision. Second, a drainage device is inserted into the front part of the eye to manage fluid levels, preventing pressure build-up.

This service was performed 108 times for 73 patients

Incision to improve eye fluid flow

This procedure, known as a trabeculectomy, involves creating a small opening in the eye to improve fluid flow. This can help lower eye pressure in conditions like glaucoma. It's a common, safe procedure to protect your eye health.

This service was performed 17 times for 17 patients

Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml

This solution is used during eye surgery to maintain pupil dilation and reduce inflammation. Phenylephrine widens the pupil, while Ketorolac helps to prevent pain and swelling. It's applied directly to the eye by your healthcare provider during the procedure.

This service was performed 532 times for 103 patients

Processing, preserving and transporting corneal tissue

Processing, preserving, and transporting corneal tissue involve careful steps to ensure its viability for transplantation. The tissue is first cleaned, then preserved in a special solution. It's packed in a temperature-controlled container for safe transport to its destination.

This service was performed 20 times for 15 patients

Removal of cataract with insertion of prosthetic lens

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.

This service was performed 1,408 times for 852 patients

Removal of recurring cataract in lens capsule using a laser

This procedure, known as YAG laser capsulotomy, treats cloudiness in the lens capsule following cataract surgery. A laser is used to create a small hole in the cloudy capsule, allowing light to pass through and restore clear vision. It's a quick, painless procedure.

This service was performed 620 times for 433 patients

Removal or relocation of corneal conjunctiva with graft

This procedure involves the removal or relocation of the conjunctiva, a thin layer covering the white part of your eye, and replacing it with a graft. This is typically done to treat conditions affecting the eye's surface, improving comfort and vision.

This service was performed 17 times for 15 patients

Transplantation of outer layer of corneal tissue

The transplantation of the outer layer of corneal tissue is a procedure to replace damaged or diseased corneal tissue with healthy tissue from a donor. This can improve vision and alleviate pain or discomfort.

This service was performed 21 times for 16 patients

CLIA 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
05D1008140
Facility Type
Ambulatory Surgery Center
Certificate Effective Date
January 10, 2025
Certificate Expiration Date
January 09, 2027
Laboratory Director
DR. NINA NI
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to 4th Street Laser & Surgery Center Inc 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 1902964174, we treat the final digit (4) 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 66. The final step is to find the difference between that total and the next multiple of ten (70 - 66 = 4).

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.

Pos 1
1
Doubled → 2
Pos 2
9
Unchanged
Pos 3
0
Doubled → 0
Pos 4
2
Unchanged
Pos 5
9
Doubled → 18 → 1 + 8
Pos 6
6
Unchanged
Pos 7
4
Doubled → 8
Pos 8
1
Unchanged
Pos 9
7
Doubled → 14 → 1 + 4
Check
4
Target digit
Regular digit Doubled digit Check digit

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.

1 → 2 0 → 0 9 → 18 → 9 4 → 8 7 → 14 → 5

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 9 + 0 + 2 + 1 + 8 + 6 + 8 + 1 + 1 + 4 + 24 = 66

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 66 is 70. The difference is the calculated check digit.

70 - 66 = 4
This NPI is valid
The calculated check digit is 4, which matches the last digit of 1902964174.

Other Providers at the Same Location


The following 1 provider is registered at the same or a nearby location.

Clinic/Center (Ambulatory Surgical)
1720 4TH ST
SANTA ROSA, CA 95404

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1902964174, enumerated as an "organization" on December 04, 2006.

The provider is located at 1720 4TH ST SANTA ROSA, CA 95404 and the phone number is (707) 546-8100.

Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.