Active NPI
Jamboor Medical Corporation
Doing business as Desert Cities Dialysis-Amethyst
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Victorville, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- JAMBOOR MEDICAL CORPORATION
- Doing business as
- Desert Cities Dialysis-Amethyst
- Practice address
- 11883 Amethyst Rd
Victorville, CA 92392-9224 - Phone
- (760) 241-8063
- Fax
- (760) 241-5037
- NPI assigned
- Aug 1, 2013
- Last updated
- Apr 27, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jay E Shankar, M.D.
- Title
- Ceo/President
- Phone
- (760) 241-8063
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Primary |
Addresses
Primary practice location
11883 Amethyst Rd
Victorville, CA 92392-9224
Mailing address
12675 Hesperia Rd
Victorville, CA 92395-5878
Phone (760) 241-8063
Other names 1
- Desert Cities Dialysis-Amethyst
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141218001425 | CA | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 5193724755 | Practice locations: Victorville, CA |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Desert Cities Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Victorville, CA
- NPI 1063421212
5193724755
-
dba Desert Cities Dialysis of Barstow
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Barstow, CA
- NPI 1457362261
5193724755
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- Desert Cities Dialysis-Amethyst
- Overall star rating
- Ownership
- Profit
- Certified
- Sep 5, 2014
- Medicare certification status
- Active
- Dialysis stations
- 26
Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2071670 | Desert Cities Dialysis | Certificate of waiver | Jan 15, 2028 |
National Provider Directory
National Provider Directory- Tax ID family
- Jamboor Medical Corporation
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Desert Cities Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Victorville, CA
- NPI 1063421212
-
dba Desert Cities Dialysis of Barstow
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Barstow, CA
- NPI 1457362261
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Nephrology Physician
- Victorville, CA
- NPI 1164431318
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Nephrology Physician
- Victorville, CA
- NPI 1821293382
Dialysis facility
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375315200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1651017600000",
"number": "1225460264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12675 HESPERIA RD",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923955878",
"telephone_number": "760-241-8063",
"fax_number": "760-241-5037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11883 AMETHYST RD",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923929224",
"telephone_number": "760-241-8063",
"fax_number": "760-241-5037"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JAMBOOR MEDICAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2013-08-01",
"last_updated": "2022-04-27",
"certification_date": "2022-04-27",
"status": "A",
"authorized_official_last_name": "SHANKAR",
"authorized_official_first_name": "JAY",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "CEO/PRESIDENT",
"authorized_official_telephone_number": "760-241-8063",
"authorized_official_credential": "M.D."
},
"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": "Desert Cities Dialysis-Amethyst",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Desert Cities Dialysis-Amethyst",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.