NPIMap

Organization Active NPI

Dva Renal Healthcare Inc

Doing business as Benicia Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Benicia, CA
National Provider Identifier
1427022797
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
110000442 Issued in CA
Legal business name
DVA RENAL HEALTHCARE INC
Doing business as
Benicia Dialysis
Practice address
560 1St St
Ste D103
Benicia, CA 94510-3293
Phone
(707) 745-1488
Fax
(707) 745-8089
NPI assigned
Feb 14, 2006
Last updated
Jan 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 110000442 CA Primary

Addresses

Primary practice location

560 1St St
Ste D103
Benicia, CA 94510-3293

Mailing address

5200 Virginia Way
L&C Department
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
1427022797MedicaidCA

Other names 1

  • Benicia Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030207000015 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 0840107611 Practice locations: Benicia, CA

National Provider Directory

National Provider Directory
Tax ID family
Dva Renal Healthcare Inc173 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737417600000",
    "number": "1427022797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 1ST ST",
            "address_2": "STE D103",
            "city": "BENICIA",
            "state": "CA",
            "postal_code": "945103293",
            "telephone_number": "707-745-1488",
            "fax_number": "707-745-8089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-14",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "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": "CA",
            "license": "110000442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1427022797",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benicia Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Benicia Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benicia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.