Pearl Dialysis, LLC

Primary specialty

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

Legal business name

PEARL DIALYSIS, LLC

Practice address

14050 Pilot Knob Rd
Ste 100
Apple Valley, MN 55124-6648

Phone

(952) 423-4062

Fax

(952) 423-6974

NPI assigned

May 1, 2013

Organization subpart

No

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

Authorized official

Name

John D Winstel

Title

Chief Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other names 1

• East Valley Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Listed as

DaVita East Valley DialysisCCN 242589

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Dec 5, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

16

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

Locations

Affiliated clinicians 8

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

• Samuel Joshua Katz, DO

  • Nephrology Physician
  • St Louis Park, MN
  • NPI 1568969970

  Dialysis facility

  Care Compare affiliation Name & address match
• Islam Khan

  • Nephrology Physician
  • Saint Paul, MN
  • NPI 1568677755

  Dialysis facility

  Care Compare affiliation Name & address match
• Andrew Emil Kummer, M.D.

  • Nephrology Physician
  • Saint Paul, MN
  • NPI 1205098464

  Dialysis facility

  Care Compare affiliation Name & address match
• Alec David Otteman, M.D.

  • Nephrology Physician
  • Maplewood, MN
  • NPI 1619138849

  Dialysis facility

  Care Compare affiliation Name & address match
• Oliver Tan Phan, MD

  • Nephrology Physician
  • Edina, MN
  • NPI 1942463229

  Dialysis facility

  Care Compare affiliation Name & address match
• Rajiv Ramanik Shah, M.D.

  • Nephrology Physician
  • Edina, MN
  • NPI 1366556854

  Dialysis facility

  Care Compare affiliation Name & address match
• Jiwan K. Thapa, M.D.

  • Nephrology Physician
  • Minneapolis, MN
  • NPI 1518123355

  Dialysis facility

  Care Compare affiliation Name & address match
• Samrat V Bhat, M.D

  • Nephrology Physician
  • La Crosse, WI
  • NPI 1053503607

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1083059299",
    "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": "615-320-4514",
            "fax_number": "866-594-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14050 PILOT KNOB RD",
            "address_2": "STE 100",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551246648",
            "telephone_number": "952-423-4062",
            "fax_number": "952-423-6974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARL DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-01",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "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": "East Valley Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Valley Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pavlik Mental Health
• PDG, P.a
• PDG, P.a.
• PDG, P.a.
• Kymn M Peacock
• Amber Lee Pearson, FNP-C
• Dana James Penkivech, PHARMD
• Periodontal Care, PA
• Cynthia A Peterson, MA, LP, LPCC, RPTS
• Mai-Linh Pham, LGSW

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Apple Valley, MN
• Providers in Apple Valley, MN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; 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.