NPIMap

Organization Active NPI

Jamboor Medical Corporation

Doing business as Desert Cities Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Victorville, CA
National Provider Identifier
1063421212
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
240000431 Issued in CA
Legal business name
JAMBOOR MEDICAL CORPORATION
Doing business as
Desert Cities Dialysis
Practice address
12675 Hesperia Rd
Victorville, CA 92395-5878
Phone
(760) 241-8063
Fax
(760) 241-5037
NPI assigned
Aug 5, 2006
Last updated
Apr 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Authorized official

Name
Jay Eriah Shankar, M.D.NPI 1164431318
Title
Owner
Phone
(760) 241-8063

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 240000431 CA Primary

Addresses

Primary practice location

12675 Hesperia Rd
Victorville, CA 92395-5878

Mailing address

12675 Hesperia Rd
Victorville, CA 92395-5878
Phone (760) 241-8063

Other identifiers 1

IdentifierTypeStateIssuer
240000431OtherCASTATE DHS LICENSE

Other names 1

  • Desert Cities Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061207000461 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 5193724755 Practice locations: Victorville, CA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Jamboor Medical Corporation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12675 Hesperia Rd
Victorville, CA 92395
Phone (760) 241-3306

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1063421212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12675 HESPERIA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955878",
            "telephone_number": "760-241-8063",
            "fax_number": "760-241-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12675 HESPERIA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955878",
            "telephone_number": "760-241-8063",
            "fax_number": "760-241-5037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMBOOR MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "SHANKAR",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "ERIAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-241-8063",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "240000431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DHS LICENSE",
            "identifier": "240000431",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Cities Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.