Prairie Dialysis LLC

Primary specialty

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

Legal business name

PRAIRIE DIALYSIS LLC

Practice address

721 W 1St St
Tustin, CA 92780-2903

Phone

(714) 544-0079

Fax

(714) 544-0071

NPI assigned

Apr 30, 2015

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

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Tustin Ranch DialysisCCN 552807

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jan 20, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

25

Member of 1

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

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Affiliated clinicians 3

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

• Alan Arthur Susa Cantillep, MD

  • Nephrology Physician
  • Fountain Valley, CA
  • NPI 1639517808

  Dialysis facility

  Care Compare affiliation Name & address match
• Ramani Nathan, MD

  • Nephrology Physician
  • Garden Grove, CA
  • NPI 1487623724

  Dialysis facility

  Care Compare affiliation Name & address match
• Henry Yuan, M.D.

  • Nephrology Physician
  • Orange, CA
  • NPI 1043442379

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774915200000",
    "number": "1407233240",
    "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": "721 W 1ST ST",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802903",
            "telephone_number": "714-544-0079",
            "fax_number": "714-544-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-30",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "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": "1407233240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Tustin, CA
• Providers in Tustin, 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 Mar 31, 2026; 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.