LAKE RIDGE SURGERY CENTER
NPI 1972850808
Clinic/Center - Ambulatory Surgical in Woodbridge, VA

Q: What is Lake Ridge Ambulatory Surgery Center, LLC's specialty?

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

Active since August 09, 2012CLIA 49D2050068 · Waiver

12825 MINNIEVILLE ROAD, SUITE 204, WOODBRIDGE, VA 22192(703) 357-9568(703) 357-9575 Get Directions Write a Review

NPPES record last updated: December 27, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Lake Ridge Surgery Center NPPES

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

LAKE RIDGE SURGERY CENTER (NPI 1972850808) is a healthcare organization registered as an ambulatory surgical in Woodbridge, Virginia and active in the NPI registry since August 2012. The organization holds a CLIA Waiver certificate valid through November 18, 2026 and lists Janet M Smith, Administrator, as its authorized official.

NPPES Registry Identity

NPI1972850808

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NameLAKE RIDGE AMBULATORY SURGERY CENTER, LLC

Location Address12825 MINNIEVILLE ROAD, SUITE 204Woodbridge, VA 22192

Mailing Address12825 Minnieville Road, Suite 204Woodbridge, VA 22192 · (703) 357-9568 · Fax (703) 357-9575

Phone(703) 357-9568

Fax(703) 357-9575

Organization SubpartNo

Authorized OfficialJanet M SmithAdministrator · (703) 357-9568

Enumeration DateAugust 9, 2012

Last NPPES UpdateDecember 27, 2013

✔ NPI 1972850808 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

12825 MINNIEVILLE ROAD, Woodbridge, VA 22192

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Other Names 1

Doing Business AsLake Ridge Surgery Center

Other Identifiers 1

Medicare PINQ409820001VA

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 49D2050068

Lake Ridge Ambulatory Surgery Center, LLC · Woodbridge, VA

Active · expires Nov 18, 2026

CLIA Number49D2050068

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateNovember 19, 2024

Certificate Expiration DateNovember 18, 2026

Laboratory DirectorJanette A. Beltran

Laboratory Phone(703) 357-9568

Laboratory LocationLake Ridge Ambulatory Surgery Center, LLC12825 Minnieville Road - 204, Woodbridge, VA 22192

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 3

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.

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.

22 services21 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.

12 services12 patients

Release of tendon connecting biceps muscle and shoulder using an endoscope 29828

This 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.

11 services11 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.

GREATER METROPOLITAN ORTHOPAEDIC INSTITUTE

Orthopaedic Surgery

12825 MINNIEVILLE ROAD, SUITE 201/203
WOODBRIDGE, VA 22192

Prince William County (301) 856-1682

POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM

Clinic/Center

12825 MINNIEVILLE ROAD
LAKE RIDGE, VA 22192

Prince William County (703) 523-9800

LAKE RIDGE ANESTHESIA LLC

Anesthesiology

12825 MINNIEVILLE ROAD, # 220
WOODBRIDGE, VA 22192

Prince William County (301) 829-7386

ELETHIA V WAMPLER

Physical Therapist

12825 MINNIEVILLE ROAD, SUITE 203
WOODBRIDGE, VA 22192

Prince William County (703) 971-3701

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 Lake Ridge Ambulatory Surgery Center, LLC's NPI number?

The NPI number for Lake Ridge Ambulatory Surgery Center, LLC is 1972850808. It was assigned to this organization in the NPPES registry on August 9, 2012. The provider is doing business as Lake Ridge Surgery Center.

Where is Lake Ridge Ambulatory Surgery Center, LLC located?

Lake Ridge Ambulatory Surgery Center, LLC is located at 12825 Minnieville Road Suite 204, Woodbridge, VA 22192. The listed phone number is (703) 357-9568.

What is Lake Ridge 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 Lake Ridge Ambulatory Surgery Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2050068) is associated with this NPI, valid through November 18, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lake Ridge Ambulatory Surgery Center, LLC was last updated on December 27, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.