San Joaquin Kidney Clinic, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A73135 Issued in CA

Legal business name

SAN JOAQUIN KIDNEY CLINIC, INC

Doing business as

San Joaquin Kidney Clinic, Inc

Practice address

1801 E March LN # B-265
Stockton, CA 95210-6629

Phone

(209) 546-1868

Fax

(209) 461-6505

NPI assigned

Jun 10, 2006

Last updated

Jan 29, 2025By 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. P. B. Sagireddy, M. D.NPI 1407844889

Title

Owner

Phone

(209) 546-1868

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• San Joaquin Kidney Clinic, Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

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

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 14

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.

• P B Sagireddy, MD

  • Nephrology Physician
  • Stockton, CA
  • NPI 1407844889
  Medicare reassignment Care Compare group NPD Authorized official
• Mallareddy Maddula, M.D.

  • Nephrology Physician
  • Stockton, CA
  • NPI 1487762647
  Medicare reassignment Care Compare group NPD
• Subrahmanyam Nasika, M.D.

  • Nephrology Physician
  • Stockton, CA
  • NPI 1548449846
  Medicare reassignment Care Compare group NPD
• Ajay Kumar Rachakonda, MD

  • Nephrology Physician
  • Visalia, CA
  • NPI 1467605014
  Medicare reassignment Care Compare group NPD
• Mehul Raval, MD

  • Nephrology Physician
  • Stockton, CA
  • NPI 1710157474
  Medicare reassignment Care Compare group NPD
• Tariq Asudan Shaheed, D.O.

  • Nephrology Physician
  • Sacramento, CA
  • NPI 1467802546
  Medicare reassignment Care Compare group NPD
• Vishwa Sheth, M.D.

  • Nephrology Physician
  • Stockton, CA
  • NPI 1366722365
  Medicare reassignment Care Compare group NPD
• Moiz Mohammad Dawood

  • Nephrology Physician
  • Henderson, NV
  • NPI 1407240716

  CA

  Medicare reassignment Care Compare group NPD
• Keerat Dhatt, M.D.

  • Nephrology Physician
  • French Camp, CA
  • NPI 1982133435
  Medicare reassignment
• Morteza Moosavi Farr, D.O.

  • Orthopaedic Surgery Physician
  • San Jose, CA
  • NPI 1023066891
  NPD (past)
• Athanasios Magimbi, MD

  • Pain Medicine (Anesthesiology) Physician
  • Tracy, CA
  • NPI 1851470959
  NPD (past)
• Yong L Shih, D.O

  • Surgery Physician
  • Manteca, CA
  • NPI 1477530236
  NPD (past)

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1407897358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LN # B-265",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952106629",
            "telephone_number": "209-546-1868",
            "fax_number": "209-461-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LN # B-265",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952106629",
            "telephone_number": "209-546-1868",
            "fax_number": "209-461-6505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1530 Bessie Ave Ste 107",
            "address_purpose": "LOCATION",
            "city": "Tracy",
            "state": "CA",
            "postal_code": "953763080",
            "country_code": "US",
            "telephone_number": "209-546-1868",
            "fax_number": "209-461-6505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 S Ham Ln Ste J",
            "address_purpose": "LOCATION",
            "city": "Lodi",
            "state": "CA",
            "postal_code": "952427502",
            "country_code": "US",
            "telephone_number": "209-546-1868",
            "fax_number": "209-461-6505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAN JOAQUIN KIDNEY CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "SAGIREDDY",
        "authorized_official_first_name": "P.",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-546-1868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A73135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A731351",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA0971",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Joaquin Kidney Clinic, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• San Joaquin Laser and Surgery Center
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• San Joaquin Orthotics & Prosthetics
• San Joaquin PCCM Professional Corporation
• San Joquin County Mental Health Services

• Specialist in Stockton, CA
• Providers in Stockton, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; 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.