Iroquois Dialysis LLC

Primary specialty

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

Legal business name

IROQUOIS DIALYSIS LLC

Practice address

3660 Park Sierra Dr
Ste 108
Riverside, CA 92505-3071

Phone

(951) 687-3900

Fax

(951) 687-7998

NPI assigned

Oct 17, 2014

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

• Riverside PD Central Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Iroquois Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Riverside, CA
  • NPI 1215332945

  8123340817

  Same PAC ID

Tax ID family

Iroquois Dialysis LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Iroquois Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Riverside, CA
  • NPI 1215332945
  NPD tax ID

Member of 1

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

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1306240551",
    "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": "3660 PARK SIERRA DR",
            "address_2": "STE 108",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053071",
            "telephone_number": "951-687-3900",
            "fax_number": "951-687-7998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IROQUOIS DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "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": "1306240551",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside PD Central",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Riverside PD Central",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Caren R. Ires, MD
• Eneri Iribe Perez, NONE
• Iris Davoodi Living Sober
• Ironstone Medical Clinic Inc
• Iroquois Dialysis LLC
• Gina Irvin
• Juanita Irvin
• Irwin Savodnik, M.D. & Medical Associates, Inc.
• David Robert Irwin
• Paula Michelle Irwin, MS, AMFT, APCC

• 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 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.