Usrc West Grand Prairie, LLC

Primary specialty

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

Legal business name

USRC WEST GRAND PRAIRIE, LLC

Doing business as

Premier Dialysis - West Grand Prairie

Practice address

4045 S Great Southwest Pkwy
Suite 100
Grand Prairie, TX 75052-3837

Phone

(972) 375-0028

Fax

(972) 375-0029

NPI assigned

Jan 17, 2017

Organization subpart

Yes

Parent organization

US RENAL CARE INCAs reported in NPPES

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

Authorized official

Name

Thomas L Weinberg

Title

Chairman/Authorized Official

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other names 1

• Premier Dialysis - West Grand Prairie Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

USRC Premier West Grand PrairieCCN 742510

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Oct 31, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

13

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

CLIA laboratory certificates

Part of

US Renal Care Inc

Member of 1

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

• Dallas Renal Group PA

  • Nephrology Physician
  • Dallas, TX
  • NPI 1629186168

  Member Of

  NPD member

Affiliated clinicians 3

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

• Eldrid Abraham Baez Matos, M.D.

  • Nephrology Physician
  • Dallas, TX
  • NPI 1417335951

  Dialysis facility

  Care Compare affiliation Name & address match
• Ponnaiah C. Mohan, MD

  • Nephrology Physician
  • Arlington, TX
  • NPI 1487646295

  Dialysis facility

  Care Compare affiliation Name & address match
• Smitha Reddy Pamulaparthy, MD

  • Nephrology Physician
  • Dallas, TX
  • NPI 1447328828

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1043756810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251549",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750251500",
            "telephone_number": "214-736-2732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 S GREAT SOUTHWEST PKWY",
            "address_2": "SUITE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523837",
            "telephone_number": "972-375-0028",
            "fax_number": "972-375-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USRC WEST GRAND PRAIRIE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "US RENAL CARE INC",
        "enumeration_date": "2017-01-17",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHAIRMAN/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "214-736-2700"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Dialysis - West Grand Prairie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Usrc Tarrant L P
• Katharine J. Usrey, RN
• Grace A Uwagbai, LVN
• Ezinma Bridget Uzoechina, PMHNP
• Valora Medical Management
• Jessica Vanscoyoc

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.