Hart Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

550001458 Issued in CA

Legal business name

HART DIALYSIS LLC

Practice address

1821 W Lincoln Ave
Anaheim, CA 92801-6731

Phone

(714) 765-6510

Fax

(714) 765-6515

NPI assigned

Jan 7, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Anaheim West Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Anaheim West DialysisCCN 552676

Overall star rating

3.0 of 5

Ownership

Profit

Certified

May 17, 2011

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

20

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Evelyn Becerra, LCSW

  • Clinical Social Worker
  • Anaheim, CA
  • NPI 1528727484
  NPD (past)
• Jaime Allison Carrillo, LCSW, MSW, MPH

  • Clinical Social Worker
  • Palo Alto, CA
  • NPI 1699935809
  NPD (past)

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Nausheen Ali, M.D.

  • Nephrology Physician
  • Anaheim, CA
  • NPI 1609869296

  Dialysis facility

  Care Compare affiliation Name & address match
• Nirav D Gandhi, M.D.

  • Nephrology Physician
  • Anaheim, CA
  • NPI 1649263252

  Dialysis facility

  Care Compare affiliation Name & address match
• Mohammad Ismail, MD

  • Nephrology Physician
  • Paramount, CA
  • NPI 1730105784

  Dialysis facility

  Care Compare affiliation Name & address match
• Henry Yuan, M.D.

  • Nephrology Physician
  • Orange, CA
  • NPI 1043442379

  Dialysis facility

  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1033449459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT.",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-238-3085",
            "fax_number": "800-268-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 W LINCOLN AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928016731",
            "telephone_number": "714-765-6510",
            "fax_number": "714-765-6515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HART DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-07",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "550001458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033449459",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anaheim West Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Anaheim West Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Theresa L Harris, LMFT
• Walter Clyde Harris, PA-C, D.C.
• Lawrence I. Harrison, MD
• Veronica C. Harrison, MD
• Caitlyn N Harsma
• Christy Ann Hartman, RCP
• Jennifer-Rose Andersen Hartman
• Kenneth Leonard Hartman, RPA-C
• Suzanne Lynn Hartman, RCP
• Janet Hartmann-Jones, PA

• All providers in Anaheim, CA
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.