SRS-la Habra

Primary specialty

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

Legal business name

SRS-LA HABRA

Practice address

1611 W Whittier Blvd
La Habra, CA 90631

Phone

(615) 988-7881

Fax

(855) 631-0206

NPI assigned

Jun 26, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Jerome S Tannenbaum, MD,PHDNPI 1346485638

Title

Ceo

Phone

(615) 467-0140

Specialties & licenses 1

Addresses

Other names 1

• SRS-LA HABRA, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

SRS-La Habra DialysisCCN 552852

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Oct 24, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

37

Locations

Practitioners 1

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

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

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

Affiliated clinicians 1

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

• Sridhar Kadumpalli Reddy, M.D.

  • Nephrology Physician
  • Garden Grove, CA
  • NPI 1780835447

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1417633355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 HARDING PIKE",
            "address_2": "STE 205",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372052098",
            "telephone_number": "615-988-7881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 W WHITTIER BLVD",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "90631",
            "telephone_number": "615-988-7881",
            "fax_number": "855-631-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRS-LA HABRA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "TANNENBAUM",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-467-0140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD,PHD"
    },
    "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": "SRS-LA HABRA, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Isela Solorio
• Seung Woo Son
• Soo Jin Cha O.D., Inc
• Holly Sotoodeh
• Julia Spratt, M.S., CCC-SLP
• St Jude Hospital Yorba Linda
• St. Agnes Homes Inc.
• Willie Staten
• Jeffrey John Stehly, DDS
• Dean Kent Stewart, DDS

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in La Habra, CA
• Providers in La Habra, 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 Dec 12, 2023; 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.