NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

Doing business as Stockton Home Training Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Stockton, CA
National Provider Identifier
1437124476
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DVA HEALTHCARE RENAL CARE INC
Doing business as
Stockton Home Training Dialysis
Practice address
5608 N Pershing Ave
Stockton, CA 95207-4906
Phone
(209) 954-9563
Fax
(209) 954-9938
NPI assigned
Feb 22, 2006
Last updated
Aug 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Authorized official

Name
John D. Winstel
Title
Chief Accounting Officer
Phone
(253) 733-7501

Specialties & licenses 1

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

Addresses

Primary practice location

5608 N Pershing Ave
Stockton, CA 95207-4906

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 238-3085

Other identifiers 1

IdentifierTypeStateIssuer
1437124476MedicaidCA

Other names 1

  • Stockton Home Training Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040416000379 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 7517875545 Practice locations: Stockton, CA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Stockton Home Training DialysisCCN 552523
Overall star rating
5.0 of 5
Ownership
Profit
Certified
Jul 14, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1025305Stockton Home Training Dialysis5608 N Pershing Ave, Stockton, CA 95207Certificate of waiverFeb 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Dialysis Services194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

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

View all 22

Member of 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1437124476",
    "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",
            "telephone_number": "615-238-3085",
            "fax_number": "800-268-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5608 N PERSHING AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952074906",
            "telephone_number": "209-954-9563",
            "fax_number": "209-954-9938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-7501"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437124476",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stockton Home Training Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stockton Home Training Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.