NPIMap

Organization Active NPI

Dva Renal Healthcare Inc

Doing business as Hi-Desert Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Yucca Valley, CA
National Provider Identifier
1265406045
Registry record updated Aug 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
240000630 Issued in CA
Legal business name
DVA RENAL HEALTHCARE INC
Doing business as
Hi-Desert Dialysis
Practice address
56845 29 Palms Hwy
Yucca Valley, CA 92284-2940
Phone
(760) 365-8706
Fax
(760) 228-0154
NPI assigned
Feb 16, 2006
Last updated
Aug 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2025

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

Authorized official

Name
Samuel T. Wey
Title
VP, Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 240000630 CA Primary

Addresses

Primary practice location

56845 29 Palms Hwy
Yucca Valley, CA 92284-2940

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
1265406045MedicaidCA

Other names 1

  • Hi-Desert Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030212000020 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 0840107611 Practice locations: Yucca Valley, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0962073Hi-Desert Dialysis56845 29 Palms Highway, Yucca Valley, CA 92284Certificate of waiverNov 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gambro Healthcare Hunti173 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Locations

56845 29 Palms Hwy
Yucca Valley, CA 92284
Phone (760) 365-8706

NPI Registry JSON

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755648000000",
    "number": "1265406045",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56845 29 PALMS HWY",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922842940",
            "telephone_number": "760-365-8706",
            "fax_number": "760-228-0154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-16",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T.",
        "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": "CA",
            "license": "240000630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265406045",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hi-Desert Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hi-Desert Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yucca Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; 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.