NPIMap

Organization Active NPI

Dva Renal Healthcare Inc

Doing business as Encinitas Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Encinitas, CA
National Provider Identifier
1356315329
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
080000502 Issued in CA
Legal business name
DVA RENAL HEALTHCARE INC
Doing business as
Encinitas Dialysis
Practice address
332 Santa Fe Dr
Ste 100
Encinitas, CA 92024-5143
Phone
(760) 632-2323
Fax
(760) 632-2311
NPI assigned
Feb 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 080000502 CA Primary

Addresses

Primary practice location

332 Santa Fe Dr
Ste 100
Encinitas, CA 92024-5143

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
1356315329MedicaidCA

Other names 1

  • Encinitas Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030210000008 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 0840107611 Practice locations: Encinitas, CA

National Provider Directory

National Provider Directory
Tax ID family
Gambro Healthcare Hunti173 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1356315329",
    "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": "332 SANTA FE DR",
            "address_2": "STE 100",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920245143",
            "telephone_number": "760-632-2323",
            "fax_number": "760-632-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "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": "080000502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356315329",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Encinitas Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Encinitas Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Encinitas, CA

Sources for this page

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