Wellbound of Menlo Park LLC

Primary specialty

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

Legal business name

WELLBOUND OF MENLO PARK LLC

Doing business as

Satellite Wellbound of Fremont

Practice address

39510 Paseo Padre Pkwy
Suite 100
Fremont, CA 94538-4707

Phone

(510) 953-7800

Fax

(510) 739-3810

NPI assigned

Feb 3, 2006

Last updated

Apr 12, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

WELLBOUND LLCAs reported in NPPES

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

Authorized official

Name

Bernadette Vincent

Title

President/Coo

Phone

(650) 404-3600

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Satellite Wellbound of Fremont Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Wellbound of Menlo Park LLC

  dba WellBound of Daly City

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Daly City, CA
  • NPI 1417229022

  8628989365

  Same PAC ID
• Wellbound of Menlo Park LLC

  dba WellBound of San Francisco

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Francisco, CA
  • NPI 1528221249

  8628989365

  Same PAC ID

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

CLIA laboratory certificates

Tax ID family

Satellite Wellbound of Fremont2 organizations share this tax ID, including this one

Part of

Wellbound LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wellbound of Menlo Park LLC

  dba WellBound of Daly City

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Daly City, CA
  • NPI 1417229022
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Satellite Healthcare Inc

  dba Satellite Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sacramento, CA
  • NPI 1790051761

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1144292186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SANTANA ROW",
            "address_2": "SUITE 300",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282423",
            "telephone_number": "510-953-7800",
            "fax_number": "650-625-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39510 PASEO PADRE PKWY",
            "address_2": "SUITE 100",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945384707",
            "telephone_number": "510-953-7800",
            "fax_number": "510-739-3810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLBOUND OF MENLO PARK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLBOUND LLC",
        "enumeration_date": "2006-02-03",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "VINCENT",
        "authorized_official_first_name": "BERNADETTE",
        "authorized_official_title_or_position": "PRESIDENT/COO",
        "authorized_official_telephone_number": "650-404-3600"
    },
    "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": "CDC52514F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CLIA CERTIFICATE OF WAIVER",
            "identifier": "05D1015752",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Satellite Wellbound of Fremont",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Satellite Wellbound of Fremont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonathan Sidney Weisman, DDS
• Anne Marie Weiss, PTA
• Jed Ira Weissberg, MD
• Katlyn Welch
• Wellbound of Fremont, LLC
• Steven E Wellemeyer
• Kierra Wells
• Wellspring TCM Corp
• Shawna Viann Welton, MA
• Fengjia Wen

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fremont, CA
• Providers in Fremont, 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 Apr 12, 2023; 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.