NPIMap

Organization Active NPI

Llano Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • El Cerrito, CA
National Provider Identifier
1063649242
Registry record updated Aug 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
LLANO DIALYSIS LLC
Doing business as
El Cerrito Dialysis
Practice address
10690 San Pablo Ave
El Cerrito, CA 94530-2620
Phone
(510) 528-9590
Fax
(510) 528-9803
NPI assigned
Jun 16, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2023

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

Authorized official

Name
Samuel T Wey
Title
Sr Dir Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

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

Addresses

Primary practice location

10690 San Pablo Ave
El Cerrito, CA 94530-2620

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 238-3085

Other identifiers 1

IdentifierTypeStateIssuer
1063649242MedicaidCA

Other names 1

  • El Cerrito Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090821000241 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9537211131 Practice locations: El Cerrito, CA

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Llano Dialysis LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member of 2

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

NPI Registry JSON

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1063649242",
    "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": "10690 SAN PABLO AVE",
            "city": "EL CERRITO",
            "state": "CA",
            "postal_code": "945302620",
            "telephone_number": "510-528-9590",
            "fax_number": "510-528-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LLANO DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-16",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR DIR LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063649242",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Cerrito Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "El Cerrito Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Cerrito, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.