East Portland Peritoneal Dialysis Clinic, LLC

Primary specialty

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

License

394016 Issued in OR

Legal business name

EAST PORTLAND PERITONEAL DIALYSIS CLINIC, LLC

Practice address

10802 SE Washington St
Portland, OR 97216-3118

Phone

(503) 254-4426

Fax

(503) 254-4135

NPI assigned

Jan 30, 2006

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 Official

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• U.S. Renal Care East Portland Home Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Listed as

Usrc East Portland Home DialysisCCN 382547

Ownership

Profit

Certified

Oct 18, 2005

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

2

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

Affiliated clinicians 2

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

• Chun Khai Chong, MD

  • Nephrology Physician
  • Portland, OR
  • NPI 1932367117

  Dialysis facility

  Care Compare affiliation Name & address match
• Gurvinder S Suri, MD

  • Nephrology Physician
  • Portland, OR
  • NPI 1760507867

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1093786782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5851 LEGACY CIR",
            "address_2": "STE 900",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750245966",
            "telephone_number": "214-736-2700",
            "fax_number": "214-736-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10802 SE WASHINGTON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163118",
            "telephone_number": "503-254-4426",
            "fax_number": "503-254-4135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST PORTLAND PERITONEAL DIALYSIS CLINIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2006-01-30",
        "last_updated": "2016-06-28",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "214-736-2700"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "OR",
            "license": "394016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273929",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "U.S. Renal Care East Portland Home Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• East Portland Dentistry
• East Portland Medical Associates LLC
• East Portland Neurology Clinic PC
• East Portland Optical Service
• East Portland Pediatric Clinic, P.C.
• East Portland Surgical Center LLC
• East Side Orthotics & Prosthetics, Inc.
• Adrienne East, LCSW
• Stephanie Ann East, MSW
• Lynn Ellis Eastes, ACNP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; 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.