Usrc Mauldin LLC

Primary specialty

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

Legal business name

USRC MAULDIN LLC

Practice address

1328 Highway 14
Simpsonville, SC 29681-5659

Phone

(864) 881-4015

Fax

(864) 488-1410

NPI assigned

Dec 26, 2017

Organization subpart

Yes

Parent organization

US RENAL CARE INC.As reported in NPPES

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

Authorized official

Name

Thomas L. Weinberg

Title

Chairman

Phone

(214) 736-2730

Specialties & licenses 1

Addresses

Other names 1

• US Renal Care Holly Tree Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Listed as

Usrc Holly TreeCCN 422673

Overall star rating

4.0 of 5

Ownership

Non-profit

Certified

Aug 6, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

12

Part of

US Renal Care Inc

Affiliated clinicians 1

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

• William Brian Ward, MD

  • Nephrology Physician
  • Greenville, SC
  • NPI 1427031780

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1514246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514246400000",
    "number": "1356857577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251549",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750251500",
            "telephone_number": "214-736-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1328 HIGHWAY 14",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296815659",
            "telephone_number": "864-881-4015",
            "fax_number": "864-488-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USRC MAULDIN LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "US RENAL CARE INC.",
        "enumeration_date": "2017-12-26",
        "last_updated": "2017-12-26",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "214-736-2730"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "US Renal Care Holly Tree Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Samantha Vanderveer, RN

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Simpsonville, SC
• Providers in Simpsonville, SC by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2017; 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.