Source Surgery Center LLC
NPI 1558802249 · Ambulatory Surgical Clinic/Center · Santa Monica, CA
Enrolled with Medicare as Part B Supplier - Ambulatory Surgical Center · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Source Surgery Center LLC is a Ambulatory Surgical Clinic/Center organization in Santa Monica, CA (NPI 1558802249).
Provider details
- NPI number
- 1558802249
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Timothy Davis, Owner(310) 574-2777
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
9 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
627 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 of Anesthetic And/Or Steroid Drug Into Sacral Spine Nerve Root Using Imaging Guidance, Single Level64483 | 246 | $466 |
| Injection of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Level64493 | 112 | $419 |
| Injection Procedure for Sacroiliac Joint; Provision of Anesthetic, Steroid And/Or Other Therapeutic Agent, With Or Without ArthrographyG0260 | 84 | $368 |
| Destruction of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Single Facet Joint64635 | 56 | $794 |
| Injection of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Level64490 | 43 | $440 |
| Injection of Anesthetic And/Or Steroid Drug Into Upper Or Middle Spine Nerve Root Using Imaging Guidance, Single Level |
Practice location
Mailing address
Registry dates
- Enumerated
- 2017-03-14
- Last updated
- 2020-01-21
- Certified
- 2020-01-21
Frequently asked questions
- What is Source Surgery Center LLC's NPI number?
- Source Surgery Center LLC's National Provider Identifier (NPI) is 1558802249, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Source Surgery Center LLC?
- Source Surgery Center LLC is classified in the NPPES registry as Ambulatory Surgical Clinic/Center (Ambulatory Health Care Facilities).
- Where is Source Surgery Center LLC located?
- Source Surgery Center LLC's practice location on file with NPPES is 2801 Wilshire Blvd, Santa Monica, CA 90403-4801.
- What is Source Surgery Center LLC's phone number?
- The practice phone number listed in the NPPES registry for Source Surgery Center LLC is (310) 574-2777.
- Does Source Surgery Center LLC accept Medicare?
- Source 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 Source Surgery Center LLC?
- The authorized official listed on Source Surgery Center LLC's NPPES record is Timothy Davis, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Source Surgery Center LLC's NPI active?
- Yes — Source Surgery Center LLC's NPI (1558802249) is active in the NPPES registry as of the last update on 2020-01-21.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.