Walton Dialysis LLC

Primary specialty

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

License

550002975 Issued in CA

Legal business name

WALTON DIALYSIS LLC

Doing business as

Colton Ranch Dialysis

Practice address

1405 W Valley Blvd
Ste 100
Colton, CA 92324-1963

Phone

(909) 783-7948

Fax

(909) 783-0125

NPI assigned

Mar 18, 2014

Last updated

Oct 9, 2024By the provider in NPPES

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

• Colton Ranch Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Colton Ranch DialysisCCN 552791

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Apr 21, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

32

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 2

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

• Total Renal Care, Inc

  dba College Estates Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Oxnard, CA
  • NPI 1922649938

  Member Of

  NPD member
• Total Renal Care Inc

  dba Kendall Kidney Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Miami, FL
  • NPI 1164748273

  Member Of

  NPD member

Locations

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.

• Minna F Huang, M.D.

  • Nephrology Physician
  • Upland, CA
  • NPI 1841447745
  NPD (past)

Affiliated clinicians 5

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

• Mary Phuong Bui

  • Nephrology Physician
  • Upland, CA
  • NPI 1841225224

  Dialysis facility

  Care Compare affiliation Name & address match
• Minna F Huang, M.D.

  • Nephrology Physician
  • Upland, CA
  • NPI 1841447745

  Dialysis facility

  Care Compare affiliation Name & address match
• Sreesh Gopal Iyengar, MD

  • Nephrology Physician
  • San Bernardino, CA
  • NPI 1699069146

  Dialysis facility

  Care Compare affiliation Name & address match
• Nima Naimi, D.O.

  • Nephrology Physician
  • Upland, CA
  • NPI 1740424712

  Dialysis facility

  Care Compare affiliation Name & address match
• Chirag Vaidya, MD

  • Nephrology Physician
  • Upland, CA
  • NPI 1073654570

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1395100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1063838894",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 W VALLEY BLVD",
            "address_2": "STE 100",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241963",
            "telephone_number": "909-783-7948",
            "fax_number": "909-783-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTON DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-18",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "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": "550002975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063838894",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colton Ranch Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wanda Walker
• Todd Wall, CADC II
• Andrew Anthony Wallace Sr.
• Martin Walls
• Walmart Inc. (Walmart Pharmacy 10-1692)
• Qiu Hua Wan, D.O.
• Ashley C Wang, MD
• Dennis Wang, P.A.
• Dongying Wang, DO
• Ming Yu Wang

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Colton, CA
• Providers in Colton, CA by specialty
• 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 Oct 9, 2024; 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.