NPIMap

Organization Active NPI

Bio-Medical Applications of California, Inc.

Doing business as FMC Dialysis Services of Santa Rosa North

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Santa Rosa, CA
National Provider Identifier
1316059116
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
BIO-MEDICAL APPLICATIONS OF CALIFORNIA, INC.
Doing business as
FMC Dialysis Services of Santa Rosa North
Practice address
487 Aviation Blvd # 110
Santa Rosa, CA 95403-1069
Phone
(707) 568-1755
Fax
(707) 568-7783
NPI assigned
Aug 31, 2006
Last updated
Oct 29, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Authorized official

Name
James J. Divito
Title
Vice President
Phone
(781) 699-9000

Specialties & licenses 1

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

Addresses

Primary practice location

487 Aviation Blvd # 110
Santa Rosa, CA 95403-1069

Mailing address

487 Aviation Blvd # 110
Santa Rosa, CA 95403-1069
Phone (707) 568-1755

Other identifiers 1

IdentifierTypeStateIssuer
CDC52503FMedicaidCA

Other names 1

  • FMC DIALYSIS SERVICES OF SANTA ROSA NORTH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316059116. Details of each certification follow.

  • CCN 552503 End-stage renal disease facility · Active · Name & address match · Details

End-stage renal disease facility certification: CCN 552503

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FMC DIALYSIS SERVICES OF SANTA ROSA NORTH
Certification status
Active
Provider type (POS)
End-stage renal disease facility
Participating since
Feb 5, 2003
Last certification
Sep 23, 2019
Ownership / control type
For Profit
Multi-facility organization
FRESENIUS MEDICAL CARE HOLDINGS, INC
Facility address
487 Aviation Blvd, Suite 110
Santa Rosa, CA 95403

National Provider Directory

National Provider Directory

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1316059116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "487 AVIATION BLVD # 110",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031069",
            "telephone_number": "707-568-1755",
            "fax_number": "707-568-7783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "487 AVIATION BLVD # 110",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031069",
            "telephone_number": "707-568-1755",
            "fax_number": "707-568-7783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIO-MEDICAL APPLICATIONS OF CALIFORNIA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "DIVITO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "781-699-9000"
    },
    "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": "CDC52503F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FMC DIALYSIS SERVICES OF SANTA ROSA NORTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FMC DIALYSIS SERVICES OF SANTA ROSA NORTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.