Johnson Dialysis Center LLC

Primary specialty

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

Legal business name

JOHNSON DIALYSIS CENTER LLC

Practice address

7769 Johnson St
Pembroke Pines, FL 33024-6856

Phone

(954) 962-9640

Fax

(954) 962-9641

NPI assigned

Aug 21, 2007

Organization subpart

No

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

Authorized official

Name

Keith Carrasco

Title

Administrator

Phone

(954) 962-9640

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Johnson Dialysis Center of Davie Florida LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Davie, FL
  • NPI 1720383219

  Member Of

  NPD member

Locations

Networks

• HealthSun Health Plans Network

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597104000000",
    "number": "1104019447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7769 JOHNSON ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246856",
            "telephone_number": "954-962-9640",
            "fax_number": "954-962-9641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7769 JOHNSON ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246856",
            "telephone_number": "954-962-9640",
            "fax_number": "954-962-9641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A",
        "authorized_official_last_name": "CARRASCO",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-962-9640"
    },
    "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": "000791100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John V. Williams, M.D., PA
• Jeena John
• Jewel John, PHARM.D
• Leah Elizabeth John
• Suja Mary John, FNP-BC
• Ameenah Johnson, RN
• Andrea Johnson
• Chermora Johnson, M.S.
• Colleen L Johnson, ARRN
• David L Johnson, OT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.