MK Dialysis Center at Riverside, Inc.

Primary specialty

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

Legal business name

MK DIALYSIS CENTER AT RIVERSIDE, INC.

Doing business as

Van buren Dialysis

Practice address

3595 Van Buren Blvd
Suite 101
Riverside, CA 92503-0311

Phone

(909) 542-2900

NPI assigned

Nov 5, 2009

Last updated

Jul 11, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mohammed Qutub Khan, MDNPI 1912008087

Title

President/Cfo

Phone

(951) 735-1257

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Van buren Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Van Buren DialysisCCN 552678

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Mar 17, 2011

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

18

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

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Mohammed Q Khan, M.D.

  • Specialist
  • Riverside, CA
  • NPI 1912008087
  NPD Authorized official
• Adina Tanasescu, M.D.

  • Nephrology Physician
  • Riverside, CA
  • NPI 1366494320
  NPD (past)

Affiliated clinicians 1

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

• Mohammed Q Khan, M.D.

  • Specialist
  • Riverside, CA
  • NPI 1912008087

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1245567627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3595 VAN BUREN BLVD",
            "address_2": "SUITE 101",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925030311",
            "telephone_number": "909-542-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3595 VAN BUREN BLVD",
            "address_2": "SUITE 101",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925030311",
            "telephone_number": "909-542-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MK DIALYSIS CENTER AT RIVERSIDE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-05",
        "last_updated": "2016-07-11",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "QUTUB",
        "authorized_official_title_or_position": "PRESIDENT/CFO",
        "authorized_official_telephone_number": "951-735-1257",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1245567627",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Van buren Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zachary I Miulli
• Antonio Mixon
• Lynda Mixon, D.D.S.
• Susan Miyabe, OD
• Megan Midori Miyamura, RN
• Mla 97 Enterprises LLC
• MLD Dental Inc (Chapman Smiles Center)
• Mlife Hospice Inc
• Mobile 3D Imaging, LLC
• Mobile Crisis Response Team (Ruhs BH)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Riverside, CA
• Providers in Riverside, 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 Jul 11, 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.