Usrc Villa Park, LLC

Primary specialty

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

Legal business name

USRC VILLA PARK, LLC

Practice address

200 E North Ave
Villa Park, IL 60181-1221

Phone

(630) 530-5237

Fax

(630) 530-5242

NPI assigned

Oct 9, 2012

Organization subpart

Yes

Parent organization

U.S. RENAL CARE, INC.As reported in NPPES

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

Authorized official

Name

Thomas L. Weinberg

Title

Authorized Representative

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• U.S. Renal Care Villa Park Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

CLIA laboratory certificates

Part of

US Renal Care Inc

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

{
    "created_epoch": "1349740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391644800000",
    "number": "1093067415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19119",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724036601",
            "telephone_number": "870-931-5400",
            "fax_number": "870-931-5418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E NORTH AVE",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601811221",
            "telephone_number": "630-530-5237",
            "fax_number": "630-530-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USRC VILLA PARK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2012-10-09",
        "last_updated": "2014-02-06",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "214-736-2700"
    },
    "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": "511682658001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "U.S. Renal Care Villa Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Carmen I Uribe Cardenas, DMD
• Kaitlyn Lee Urick, DPT
• Usrc VP Home, LLC
• Violeta M Valadka, RPH
• Vantage Medical Solutions LLC
• Laura Nicole Vanzandt, OTR/L
• Lauren Vargo

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Villa Park, IL
• Providers in Villa Park, IL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; 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.