Moraine Dialysis LLC

Primary specialty

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

Legal business name

MORAINE DIALYSIS LLC

Practice address

1180 W 6TH St
Ste 101
Corona, CA 92882-3135

Phone

(951) 808-9068

Fax

(951) 808-9861

NPI assigned

Apr 16, 2015

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

Cief Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other names 1

• Circle City Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Circle City DialysisCCN 552826

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Jan 10, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

33

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 3

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

• Heeten Vasudev Bhoot, D.O.

  • Nephrology Physician
  • Norco, CA
  • NPI 1740731413

  Dialysis facility

  Care Compare affiliation Name & address match
• Andrew Tze-Ray Cheung, M.D.

  • Nephrology Physician
  • Corona, CA
  • NPI 1164658662

  Dialysis facility

  Care Compare affiliation Name & address match
• Vince Hyun Ha, MD

  • Nephrology Physician
  • Corona, CA
  • NPI 1568587061

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636934400000",
    "number": "1134516206",
    "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": "615-238-3085",
            "fax_number": "800-268-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 W 6TH ST",
            "address_2": "STE 101",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928823135",
            "telephone_number": "951-808-9068",
            "fax_number": "951-808-9861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORAINE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-16",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CIEF 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": "Circle City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Circle City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elijah Anthony Allan Moore
• Laura Moore, LMFT
• Megan Nicole Moore
• Lucia Mora
• Shalanah Antonette Moraga, LVN
• Rafael Morales Toia
• Anna-Marie Morales, MT
• Brandon Morales
• Daisy Morales
• Maria Michelle Morales

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Corona, CA
• Providers in Corona, CA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; 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.