Ponderosa Pine, LLC

Primary specialty

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

Legal business name

PONDEROSA PINE, LLC

Practice address

9777 S Yosemite St Ste 130Ab&C
Lone Tree, CO 80124-3191

Phone

(720) 798-3714

Fax

(720) 798-3755

NPI assigned

Sep 13, 2021

Organization subpart

Yes

Parent organization

U.S. 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) 736-2700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

US Renal Care Inc

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Steven L Fabian, M.D.

  • Nephrology Physician
  • Lone Tree, CO
  • NPI 1942315668
  NPD (past)

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1407525447",
    "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": "9777 S YOSEMITE ST STE 130AB&C",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801243191",
            "telephone_number": "720-798-3714",
            "fax_number": "720-798-3755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDEROSA PINE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2021-09-13",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "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": "214-736-2700"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Shea Poepping, NP
• Krista M Pogge, RD
• Judson Ryan Poling, PSYD
• Alyssa Starr Pollman, FNP-BC
• Elizabeth Polsin
• Meagan Poore Burrus, ARNP
• Stephen Norris Pope-Rolewski, PA
• Jamie Michelle Porter
• Portercare Adventist Health System
• Portercare Adventist Health System

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Lone Tree, CO
• Providers in Lone Tree, CO by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; 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.