Tarleton Dialysis LLC

Primary specialty

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

Legal business name

TARLETON DIALYSIS LLC

Doing business as

Canutillo Dialysis

Practice address

7251 S Desert Blvd
Canutillo, TX 79835-2200

Phone

(915) 877-4907

Fax

(915) 877-4912

NPI assigned

May 24, 2018

Last updated

Dec 21, 2023By 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

Samuel Wey

Title

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Canutillo Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

DaVita Canutillo DialysisCCN 742528

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Mar 13, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

25

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.

• Renal Treatment Centers-Southeast, LP.

  dba Hot Springs Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hot Springs, AR
  • NPI 1881938207

  Member Of

  NPD member

Locations

Affiliated clinicians 2

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

• German T. Hernandez, M.D.

  • Nephrology Physician
  • El Paso, TX
  • NPI 1154367704

  Dialysis facility

  Care Compare affiliation Name & address match
• Simon Sergio Rodriguez, M.D.

  • Nephrology Physician
  • El Paso, TX
  • NPI 1952512246

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703116800000",
    "number": "1245721398",
    "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": "615-320-4224",
            "fax_number": "800-293-4707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7251 S DESERT BLVD",
            "city": "CANUTILLO",
            "state": "TX",
            "postal_code": "798352200",
            "telephone_number": "915-877-4907",
            "fax_number": "915-877-4912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TARLETON DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-24",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP, LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "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": "3959777-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canutillo Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Romano, RD
• Christopher Romero
• Elizabeth Rosalez, LMHC
• Liliana Sandoval, LVN
• Griselda Anabel Stewart, LMSW
• To the Moon and Back Personal Care LLC
• Daena Torres, LMHC
• Total Care Institute PLLC
• Lorena Trevizo
• Sam Tilden Tyson, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Canutillo, TX
• Providers in Canutillo, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.