Davita Riverside II LLC

Primary specialty

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

License

550000177 Issued in CA

Legal business name

DAVITA RIVERSIDE II LLC

Doing business as

Magnolia West Dialysis

Practice address

11161 Magnolia Ave
Riverside, CA 92505-3605

Phone

(951) 351-8090

Fax

(951) 351-8099

NPI assigned

Jul 11, 2006

Last updated

Apr 4, 2024By 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

• Magnolia West Dialysis 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).

• Davita Riverside II LLC

  dba Eastvale Preserve Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Eastvale, CA
  • NPI 1033159264

  5799787420

  Same PAC ID

Listed as

DaVita Magnolia West DialysisCCN 552553

Overall star rating

3.0 of 5

Ownership

Profit

Certified

May 26, 2006

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

30

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

CLIA laboratory certificates

Member of 1

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

• Renal Treatment Centers California Inc

  dba Valley View Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Moreno Valley, CA
  • NPI 1407819485

  Member Of

  NPD member

Locations

Affiliated clinicians 4

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

• Rizwan Badar, M.D.

  • Nephrology Physician
  • Riverside, CA
  • NPI 1073761243

  Dialysis facility

  Care Compare affiliation Name & address match
• Taher M. Attia Khalil, M.D.

  • Nephrology Physician
  • Riverside, CA
  • NPI 1962458752

  Dialysis facility

  Care Compare affiliation Name & address match
• Kirollos Zaki, D.O

  • Nephrology Physician
  • Riverside, CA
  • NPI 1104270305

  Dialysis facility

  Care Compare affiliation Name & address match
• Dalia M Zaky Dawoud, MD

  • Nephrology Physician
  • Riverside, CA
  • NPI 1508026386

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1316971641",
    "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",
            "telephone_number": "615-238-3085",
            "fax_number": "800-268-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11161 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053605",
            "telephone_number": "951-351-8090",
            "fax_number": "951-351-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVITA RIVERSIDE II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "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": "550000177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316971641",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia West Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Magnolia West Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Lloyd Davis, MD
• Tjera Davis
• Tjhomas M Davis
• Tonisha Degina Davis
• Vanessa D Davis
• Iris Davoodi
• Sarah Dawes
• Shanena Dawkins
• Stanley Dawkins
• Andrew Dawson

• 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 Apr 4, 2024; 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.