Barnell Dialysis, LLC

Primary specialty

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

License

110257 Issued in TX

Legal business name

BARNELL DIALYSIS, LLC

Doing business as

Pine Park Dialysis

Practice address

3333 Bayshore Blvd
Pasadena, TX 77504-1952

Phone

(713) 943-1463

Fax

(713) 943-1481

NPI assigned

Jan 11, 2014

Last updated

Mar 19, 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

Samuel T Wey

Title

VP Licensure&Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pine Park Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

DaVita Pine Park DialysisCCN 672767

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Jan 21, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

24

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

CLIA laboratory certificates

Member of 2

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

• Bainbridge Dialysis LLC

  dba Central Fort Worth Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Worth, TX
  • NPI 1699041152

  Member Of

  NPD member
• Renal Treatment Centers-Southeast, LP.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sherman, TX
  • NPI 1316901036

  Member Of

  NPD member

Affiliated clinicians 4

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

• Tahir Hafeez, M.D.

  • Nephrology Physician
  • Baytown, TX
  • NPI 1770516510

  Dialysis facility

  Care Compare affiliation Name & address match
• Vijay K Koka, MD

  • Nephrology Physician
  • Pasadena, TX
  • NPI 1144423922

  Dialysis facility

  Care Compare affiliation Name & address match
• Ugochi A Osborn, MD

  • Nephrology Physician
  • Pasadena, TX
  • NPI 1932442084

  Dialysis facility

  Care Compare affiliation Name & address match
• Chau Minh Vu, M.D.

  • Specialist
  • Webster, TX
  • NPI 1689671497

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1389398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1457773368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BAYSHORE BLVD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775041952",
            "telephone_number": "713-943-1463",
            "fax_number": "713-943-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARNELL DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-11",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "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": "TX",
            "license": "110257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360177501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pine Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rachel Wang Baltazar, OD
• Nourah Abusharbain Banks, CRNA
• Amit K Bansal, MD
• John Henry Barber III, PTA
• Jo Carroll Barham, CRNA
• Nayeli Isalynn Barrera
• David Barrios
• John C Bartley, LCSW
• Barbara Barton, RN
• Robert Alan Barton, D.C.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pasadena, TX
• Providers in Pasadena, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.