SRS-Crescent City, LLC

Primary specialty

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

Legal business name

SRS-CRESCENT CITY, LLC

Practice address

780 E Washington Blvd
Building B
Crescent City, CA 95531-8397

Phone

(615) 467-0140

NPI assigned

Mar 21, 2017

Last updated

Nov 23, 2020By 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

Dr. Jerome Tannenbaum, MD, PHD, FACPNPI 1346485638

Title

Ceo

Phone

(615) 467-0140

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

SRS-Crescent City, LLCCCN 552868

Overall star rating

1.0 of 5

Ownership

Profit

Certified

May 3, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

9

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jerome Seymour Tannenbaum, M.D., PH.D.

  • Nephrology Physician
  • Nashville, TN
  • NPI 1346485638
  NPD (past) Authorized official

Affiliated clinicians 3

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

• Benjamin Fritz, M.D.

  • Nephrology Physician
  • Santa Rosa, CA
  • NPI 1265482772

  Dialysis facility

  Care Compare affiliation Name & address match
• Allen Sebastian Mathew, MD

  • Nephrology Physician
  • Eureka, CA
  • NPI 1417053075

  Dialysis facility

  Care Compare affiliation Name & address match
• Robert F Quigley, DO

  • Nephrology Physician
  • Reno, NV
  • NPI 1104907674

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1376074559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198813",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372198397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 E WASHINGTON BLVD",
            "address_2": "BUILDING B",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318397",
            "telephone_number": "615-467-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRS-CRESCENT CITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-21",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "TANNENBAUM",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-467-0140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD, FACP"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Snow, LCSW
• Soft Tissue and Myofascial Treatment Inc (Myofascial Treatment Center)
• Sound Inpatient Physicians Medical Group, Inc
• Shelley Allison Sovola, L.AC.,OMD
• Saundra Sue Squires, LMFT
• Mark St James, RN
• Stallant Medical Group Inc
• James Standring, DDS
• Michael John Standring, MA, DMD
• Chris Ann Starets-Foote, MFT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Crescent City, CA
• Providers in Crescent City, 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 Nov 23, 2020; 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.