Ponderosa Dialysis LLC

Primary specialty

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

Legal business name

PONDEROSA DIALYSIS LLC

Doing business as

Victory Lakes Dialysis

Practice address

3290 Gulf Fwy S Ste H
Dickinson, TX 77539-4542

Phone

(281) 337-2175

Fax

(281) 337-2386

NPI assigned

Apr 3, 2013

Last updated

Jul 7, 2026By 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 T Wey

Title

VP Licensure&Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Victory Lakes Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

DaVita Victory Lakes DialysisCCN 672754

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Feb 27, 2015

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

Member of 1

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

• Renal Treatment Centers-Southeast, LP.

  dba Barbour County Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Eufaula, AL
  • NPI 1326583188

  Member Of

  NPD member

Locations

Affiliated clinicians 1

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

• Tina Kochar, MD

  • Nephrology Physician
  • Galveston, TX
  • NPI 1902000573

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783382400000",
    "number": "1275876633",
    "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": "3290 GULF FWY S STE H",
            "city": "DICKINSON",
            "state": "TX",
            "postal_code": "775394542",
            "telephone_number": "281-337-2175",
            "fax_number": "281-337-2386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDEROSA DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-03",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3469405-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victory Lakes Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Victory Lakes Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bryce Penney, MS, LPC ASSOCIATE
• Rosemary L. Perez
• Fannita Phillips
• Nam Manh Phung, DMD
• Peter Polak, PHARM.D
• Miranda Jalene Pool, PHYSICIAN ASSISTANT
• Terrie Porras, N.D.
• Jolie Powell
• Precision Mind and Body
• Precision PHS LLC (Precision Rx)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Dickinson, TX
• Providers in Dickinson, 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 Jul 7, 2026; 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.