Bothwell Dialysis LLC

Primary specialty

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

Legal business name

BOTHWELL DIALYSIS LLC

Practice address

8787 Fallbrook Dr
Houston, TX 77064-3318

Phone

(281) 477-7878

Fax

(281) 955-0015

NPI assigned

Sep 19, 2014

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

• Jersey Village Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

DaVita Jersey Village DialysisCCN 672781

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Jul 27, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

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

Member of 1

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

• Renal Treatment Centers-Southeast, LP.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Donna, TX
  • NPI 1902353543

  Member Of

  NPD member

Locations

Affiliated clinicians 6

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

• Ulka Mahesh Desai, M.D.

  • Nephrology Physician
  • Houston, TX
  • NPI 1841481025

  Dialysis facility

  Care Compare affiliation Name & address match
• Tsegaw Erko Egziti, M.D.

  • Nephrology Physician
  • Houston, TX
  • NPI 1982995213

  Dialysis facility

  Care Compare affiliation Name & address match
• Jonathan Daniel Pankow, MD

  • Nephrology Physician
  • Houston, TX
  • NPI 1962817783

  Dialysis facility

  Care Compare affiliation Name & address match
• Mohamed Ali Sheta, M.D.

  • Nephrology Physician
  • Houston, TX
  • NPI 1457666570

  Dialysis facility

  Care Compare affiliation Name & address match
• Ghayyath Sultan, M.D

  • Nephrology Physician
  • Houston, TX
  • NPI 1780913996

  Dialysis facility

  Care Compare affiliation Name & address match
• Colville T. Williams

  • Nephrology Physician
  • Houston, TX
  • NPI 1861490005

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1326440512",
    "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": "8787 FALLBROOK DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770643318",
            "telephone_number": "281-477-7878",
            "fax_number": "281-955-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTHWELL DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-19",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "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": "367032501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jersey Village Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jersey Village Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elaine Botello, PHARM.D.
• Monica Botello
• Yesenia Botello
• Rafael C Botero, M.D.
• Asheesh Bothra, M.B.,B.S.
• Joy Kanany Botros, PT, DPT
• Mena Botros, MD
• Lindsay Botsford, M.D.
• Lisa Bott, CRNA
• Peter Kenneth Bott, CRNA

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Houston, TX
• Providers in Houston, 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 Mar 19, 2025; 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.