Pure Life Renal of Overland Park, LLC

Primary specialty

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

Legal business name

PURE LIFE RENAL OF OVERLAND PARK, LLC

Practice address

11661 College Blvd Ste 106
Overland Park, KS 66210-4107

Phone

(954) 962-5733

NPI assigned

Feb 27, 2020

Organization subpart

No

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

Authorized official

Name

Jeff Fernandez

Title

Cfo

Phone

(954) 962-5733

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Listed as

Pure Life Renal of Overland Park LLCCCN 172576

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Jun 2, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

17

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

CLIA laboratory certificates

Locations

Affiliated clinicians 1

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

• Tarek Darwish, MD

  • Nephrology Physician
  • Overland Park, KS
  • NPI 1790712750

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1083248181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 HOLLYWOOD BLVD STE 300N",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330211242",
            "telephone_number": "954-962-5733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11661 COLLEGE BLVD STE 106",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662104107",
            "telephone_number": "954-962-5733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE LIFE RENAL OF OVERLAND PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "954-962-5733"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pulmacare LLC
• Pulmonary Medicine Assoc P C
• Audrey Pumphrey
• Karmendeep Singh Punia, PHARM D.
• Kevin James Punswick, DO
• Purehealth Clinics PA, LLC
• Michael David Puricelli, M.D.
• Cindy L. Purifoy, TLMFT
• Purpose Driven Transportation LLC
• Corrin Pursell, LPC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Overland Park, KS
• Providers in Overland Park, KS by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; 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.