Usrc Mustang Dialysis, LLC

Primary specialty

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

Legal business name

USRC MUSTANG DIALYSIS, LLC

Practice address

12250 Tamiami TRL E Ste 103&104
Naples, FL 34113-8108

Phone

(239) 610-1241

Fax

(239) 610-1261

NPI assigned

Feb 4, 2021

Organization subpart

Yes

Parent organization

U.S. RENAL CARE, INC.As reported in NPPES

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

Authorized official

Name

Thomas L Weinberg

Title

Chairman/President

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other names 1

• U.S. Renal Care Mustang Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

USRC MustangCCN 682729

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Oct 27, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

12

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

CLIA laboratory certificates

Part of

US Renal Care Inc

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Steven Russo, MD, PHD

  • Nephrology Physician
  • Naples, FL
  • NPI 1316934326
  NPD (past)

Affiliated clinicians 3

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

• Ramu Patakoti, MD

  • Nephrology Physician
  • Naples, FL
  • NPI 1942484902

  Dialysis facility

  Care Compare affiliation Name & address match
• Mark Steven Russo, MD, PHD

  • Nephrology Physician
  • Naples, FL
  • NPI 1316934326

  Dialysis facility

  Care Compare affiliation Name & address match
• Vera Stricevic, M.D.

  • Nephrology Physician
  • Naples, FL
  • NPI 1104858968

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1285226902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251549",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750251500",
            "telephone_number": "214-736-2700",
            "fax_number": "214-736-2701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12250 TAMIAMI TRL E STE 103&104",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341138108",
            "telephone_number": "239-610-1241",
            "fax_number": "239-610-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USRC MUSTANG DIALYSIS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHAIRMAN/PRESIDENT",
        "authorized_official_telephone_number": "214-736-2700"
    },
    "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": "U.S. Renal Care Mustang Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Amanda R. Uriarte, PA-C
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• US Wound Care, LLC
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• Usrx Pharmacy LLC
• Usv Optical Inc.
• Vincent Michael Vaccaro, MD
• Stacy Ann Vadakkan, DMD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Naples, FL
• Providers in Naples, FL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.