SURGCENTER OF FAYETTEVILLE, LLC
NPI 1477178879
Clinic/Center - Ambulatory Surgical in Fayetteville, AR

NPI Status: Active since June 11, 2020

Contact Information

1905 E MISSION BLVD STE 5
FAYETTEVILLE, AR
ZIP 72703
Phone: (501) 554-1273

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  • Organization
  • Clinic/Center
  • Ambulatory Surgical
  • Accepts Insurance
  • CLIA Number: 04D2187757
  • CLIA Cert. Type: Ambulatory Surgery Center
  • CLIA Exp. Date: 07-06-2026

About SURGCENTER OF FAYETTEVILLE, LLC

This page provides the complete NPI Profile along with additional information for Surgcenter Of Fayetteville, Llc, a provider established in Fayetteville, Arkansas operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1477178879 assigned on June 2020. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 5 years ago. The authorized official of this NPI record is Kelli Young Rn (Adminsitrator)

NPI
1477178879
Provider Name
SURGCENTER OF FAYETTEVILLE, LLC
Entity Type
Organization
Location Address
1905 E MISSION BLVD STE 5 FAYETTEVILLE, AR 72703
Location Phone
(501) 554-1273
Mailing Address
1905 E MISSION BLVD STE 5 FAYETTEVILLE, AR 72703
Mailing Phone
(501) 554-1273
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
06-11-2020
Last Update Date
06-11-2020
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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

Insurance Plans Accepted

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

  • Choice Bronze HSA (QualChoice) - POS
  • Complete Gold - PPO
  • Complete Gold + Vision + Adult Dental - PPO
  • Complete Silver (QualChoice) - POS
  • Connected Silver - PPO
  • Connected Silver (QualChoice) - POS
  • Connected Silver (QualChoiceLife) - PPO
  • Connected Silver + Vision + Adult Dental - PPO
  • Elite Bronze - PPO
  • Elite Bronze + Vision + Adult Dental - PPO
  • Elite Gold (QualChoice) - POS
  • Elite Gold (QualChoiceLife) - PPO
  • Everyday Bronze - PPO
  • Everyday Bronze + Vision + Adult Dental - PPO
  • Everyday Gold - PPO
  • Everyday Gold + Vision + Adult Dental - PPO
  • Everyday Silver (QualChoiceLife) - PPO
  • Focused Silver - PPO
  • Focused Silver + Vision + Adult Dental - PPO
  • Standard Expanded Bronze - PPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Complete Silver - EPO
  • Complete Silver + Vision + Adult Dental - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Everyday Gold - EPO
  • Everyday Gold + Vision + Adult Dental - EPO
  • Premier Silver - EPO
  • Premier Silver + Vision + Adult Dental - EPO
  • Standard Expanded Bronze - EPO
  • Standard Expanded Bronze + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Standard Silver - EPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Elite Gold - EPO
  • Elite Gold + Vision + Adult Dental - EPO
  • Elite Silver - EPO
  • Elite Silver + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Standard Expanded Bronze - EPO
  • Standard Expanded Bronze + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Standard Silver - EPO
  • Choice Bronze HSA - HMO
  • Choice Bronze HSA + Vision + Adult Dental - HMO
  • Complete Gold - HMO
  • Complete Gold + Vision + Adult Dental - HMO
  • Complete Silver - HMO
  • Complete Silver + Vision + Adult Dental - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Everyday Gold - HMO
  • Everyday Gold + Vision + Adult Dental - HMO
  • Focused Silver - HMO
  • Focused Silver + Vision + Adult Dental - HMO
  • Standard Expanded Bronze - HMO
  • Standard Expanded Bronze + Vision + Adult Dental - HMO
  • Standard Gold - HMO
  • Standard Gold + Vision + Adult Dental - HMO
  • Standard Silver - HMO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Complete Silver - EPO
  • Complete Silver + Vision + Adult Dental - EPO
  • Everyday Gold - EPO
  • Everyday Gold + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Standard Silver - EPO
  • Elite Bronze - PPO
  • Elite Bronze + Vision + Adult Dental - PPO
  • Elite Gold - PPO
  • Elite Gold + Vision + Adult Dental - PPO
  • Everyday Bronze - PPO
  • Everyday Bronze + Vision + Adult Dental - PPO
  • Everyday Gold - PPO
  • Everyday Gold + Vision + Adult Dental - PPO
  • Focused Silver - PPO
  • Focused Silver + Vision + Adult Dental - PPO
  • Standard Expanded Bronze - PPO
  • Standard Expanded Bronze + Vision + Adult Dental - PPO
  • Standard Gold - PPO
  • Standard Gold + Vision + Adult Dental - PPO
  • Standard Silver - PPO
  • Clear Silver - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Elite Gold - EPO
  • Elite Gold + Vision + Adult Dental - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Everyday Gold - EPO
  • Everyday Gold + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Standard Expanded Bronze - EPO
  • Standard Expanded Bronze + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Standard Silver - EPO
  • Standard Silver + Vision + Adult Dental - EPO
  • Bronze Exp Standardized - PPO
  • Bronze Value - PPO
  • Gold Standardized - PPO
  • Silver AH - PPO
  • Silver Standardized - PPO
  • Silver Value - PPO
  • Dental Gold - PPO
  • Dental Gold Plus Vision - PPO
  • Dental Pediatric - PPO
  • Dental Platinum - PPO
  • Dental Platinum Plus Vision - PPO
  • Dental Platinum Premium - PPO
  • Dental Platinum Premium Plus Vision - PPO
  • Dental Silver - PPO
  • HA Bronze Exp Standardized - POS
  • HA Bronze Suitcase - POS
  • HA Gold Standardized - POS
  • HA Silver AH - POS
  • HA Silver Premier Suitcase - POS
  • HA Silver Standardized - POS
  • Octave Bronze Exp Standardized - POS
  • Octave Bronze Value - POS
  • Octave Gold Standardized - POS
  • Octave Silver AH - POS
  • Octave Silver Classic Suitcase - POS
  • Octave Silver Standardized - POS

*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

KELLI YOUNG RN

Authorized Official Title
ADMINSITRATOR
Authorized Official Phone
(501) 554-1273

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.

Aspiration and/or injection of fluid from large joint

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

This service was performed 24 times for 18 patients

Correction of toe joint deformity

Correction of toe joint deformity is a procedure to fix misshapen toe joints. This can involve realigning the bones, removing bone or tissue, or implanting devices to improve joint function. It can help reduce pain and improve mobility.

This service was performed 29 times for 20 patients

Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint

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.

This service was performed 102 times for 53 patients

Fusion of big toe at joint with foot

Fusion of the big toe at the joint with the foot, also known as arthrodesis, is a surgical procedure aimed at relieving pain and improving stability. It involves permanently connecting the bones of the big toe and foot, which can limit movement but often enhances comfort and function.

This service was performed 31 times for 29 patients

Imaging guidance for procedure, 60 minutes or less

Imaging guidance is a procedure where real-time images are used to direct medical tools during a treatment. This technique helps to improve accuracy and safety. The procedure typically lasts 60 minutes or less.

This service was performed 56 times for 53 patients

Incision of tendon covering of finger

This procedure involves making a small cut into the protective sheath around a finger tendon. It's typically done to relieve pressure or inflammation, improve finger movement, or treat conditions like trigger finger. It's a safe, often outpatient procedure.

This service was performed 32 times for 24 patients

Incision or partial removal of foot bone (other than big toe) to straighten toe

This procedure involves making a small incision to partially remove a bone in the foot, excluding the big toe. The aim is to straighten a misaligned toe. It helps in relieving pain, improving foot function, and enhancing shoe comfort.

This service was performed 11 times for 11 patients

Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level

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.

This service was performed 771 times for 361 patients

Injection of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance, single level

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.

This service was performed 26 times for 11 patients

Injection of lower or sacral spine facet joint using imaging guidance, single level

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.

This service was performed 158 times for 58 patients

Injection of substance into lower spine canal using imaging guidance

This procedure involves injecting a substance into your lower spine canal, guided by real-time images. It's done to diagnose or treat various conditions. You may feel slight discomfort, but it's generally safe and can provide valuable information for your treatment plan.

This service was performed 64 times for 47 patients

Injection of substance into middle or upper spine canal using imaging guidance

This procedure involves injecting a substance into your middle or upper spine canal. It's performed under imaging guidance to ensure accuracy. The substance can help diagnose or treat various conditions, providing relief from symptoms.

This service was performed 118 times for 93 patients

Injection of upper or middle spine facet joint using imaging guidance, single level

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.

This service was performed 38 times for 15 patients

Insertion of spinal neurostimulator electrode array through skin

This procedure involves placing a small device, called a neurostimulator electrode array, under your skin near your spine. It delivers mild electrical signals to your spinal cord, helping to manage chronic pain.

This service was performed 134 times for 50 patients

Insertion of spinal neurostimulator generator or receiver

The insertion of a spinal neurostimulator generator or receiver is a procedure to manage chronic pain. A small device is implanted under your skin, which sends mild electrical signals to your spinal cord. These signals disrupt pain signals, helping to reduce discomfort.

This service was performed 46 times for 46 patients

Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 segment

This procedure involves removing part of a spine bone to alleviate pressure on the lower spinal cord and/or nerves. It targets a single segment of the spine, improving mobility and reducing pain. It's a common treatment for conditions like herniated discs or spinal stenosis.

This service was performed 22 times for 22 patients

Placement of stabilizing device to lower spine level

The placement of a stabilizing device to the lower spine level is a procedure aimed at providing support to your back. It involves positioning a device in your lower spine to help maintain its alignment and stability, reducing pain and improving mobility.

This service was performed 12 times for 12 patients

Release and/or relocation of hand nerve

This procedure involves adjusting or moving a nerve in your hand to alleviate discomfort or improve function. The nerve may be compressed, causing pain or numbness. By releasing or relocating the nerve, these symptoms can be reduced, enhancing hand usage.

This service was performed 52 times for 43 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
04D2187757
Facility Type
Ambulatory Surgery Center
Certificate Effective Date
July 07, 2024
Certificate Expiration Date
July 06, 2026
Laboratory Director
DR. MARK MIEDEMA
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Surgcenter Of Fayetteville, Llc 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 Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1477178879
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
241472716814
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 1 + 4 + 7 + 2 + 7 + 1 + 6 + 8 + 1 + 4 + 24 = 71
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 71 = 99

The NPI number 1477178879 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


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

NPI Name / Type Taxonomy Address
1831798586FAYETTEVILLE ANESTHESIA ASSOCIATES LLC
Organization
Anesthesiology1905 E MISSION BLVD STE 5
FAYETTEVILLE, AR 72703
(479) 439-4959

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1477178879, enumerated in the NPI registry as an "organization" on June 11, 2020

The provider is located at 1905 E Mission Blvd Ste 5 Fayetteville, Ar 72703 and the phone number is (501) 554-1273

This medical organization specializes in Clinic/Center with taxonomy code 261QA1903X with a focus in Ambulatory Surgical

The provider might be accepting Accepts: Ambetter from Arkansas Health & Wellness, Ambetter. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

The most common procedures or services performed by this practitioner are: Aspiration and/or injection of fluid from large joint, Correction of toe joint deformity, Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint, Fusion of big toe at joint with foot, Imaging guidance for procedure, 60 minutes or less, Incision of tendon covering of finger, Incision or partial removal of foot bone (other than big toe) to straighten toe, Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level, Injection of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance, single level, Injection of lower or sacral spine facet joint using imaging guidance, single level, Injection of substance into lower spine canal using imaging guidance, Injection of substance into middle or upper spine canal using imaging guidance, Injection of upper or middle spine facet joint using imaging guidance, single level, Insertion of spinal neurostimulator electrode array through skin, Insertion of spinal neurostimulator generator or receiver, Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 segment, Placement of stabilizing device to lower spine level and Release and/or relocation of hand nerve.

The provider's CLIA number is 04D2187757 for a "ambulatory surgery center" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued 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..

This NPI record was last updated on June 11, 2020. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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