West Lakes Surgery Center LLC
NPI 1104933696 · Ambulatory Surgical Clinic/Center · Clive, IA
Enrolled with Medicare as Part B Supplier - Ambulatory Surgical Center · source: CMS PECOS Public Provider Enrollment (2026.04.01)
West Lakes Surgery Center LLC is a Ambulatory Surgical Clinic/Center organization in Clive, IA (NPI 1104933696).
Provider details
- NPI number
- 1104933696
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Teri Formanek, President(515) 327-1555
- License
- NA
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
20 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
5,852 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Injection, Bupivacaine Liposome, 1 MgC9290 | 3,658 | $1 |
| Instillation, Bupivacaine and Meloxicam, 1 Mg/0.03 MgC9088 | 415 | $1 |
| Injection of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Level64493 | 299 | $344 |
| Injection of Anesthetic And/Or Steroid Drug Into Sacral Spine Nerve Root Using Imaging Guidance, Single Level64483 | 213 | $389 |
| Destruction of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Single Facet Joint64635 | 199 | $789 |
| Injection Procedure for Sacroiliac Joint; Provision of Anesthetic, Steroid And/Or Other Therapeutic Agent, With Or Without ArthrographyG0260 |
Practice location
Mailing address
Registry dates
- Enumerated
- 2006-08-23
- Last updated
- 2020-06-04
- Certified
- 2020-06-04
Frequently asked questions
- What is West Lakes Surgery Center LLC's NPI number?
- West Lakes Surgery Center LLC's National Provider Identifier (NPI) is 1104933696, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is West Lakes Surgery Center LLC?
- West Lakes Surgery Center LLC is classified in the NPPES registry as Ambulatory Surgical Clinic/Center (Ambulatory Health Care Facilities).
- Where is West Lakes Surgery Center LLC located?
- West Lakes Surgery Center LLC's practice location on file with NPPES is 12499 University Ave, Clive, IA 50325-8281.
- What is West Lakes Surgery Center LLC's phone number?
- The practice phone number listed in the NPPES registry for West Lakes Surgery Center LLC is (515) 974-5050.
- Does West Lakes Surgery Center LLC accept Medicare?
- West Lakes Surgery Center LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for West Lakes Surgery Center LLC?
- The authorized official listed on West Lakes Surgery Center LLC's NPPES record is Teri Formanek, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is West Lakes Surgery Center LLC's NPI active?
- Yes — West Lakes Surgery Center LLC's NPI (1104933696) is active in the NPPES registry as of the last update on 2020-06-04.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.