Space City Dialysis Pasadena - Dsi, LLC

Primary specialty

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

Legal business name

SPACE CITY DIALYSIS PASADENA - DSI, LLC

Doing business as

US Renal Care Space City Dialysis LLC

Practice address

3402 Burke Rd
Pasadena, TX 77504-1805

Phone

(713) 425-0428

Fax

(713) 425-0427

NPI assigned

Oct 19, 2016

Last updated

Oct 19, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

US RENAL CARE INC.As reported in NPPES

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

Authorized official

Name

Thomas L Weinberg

Title

Chairman

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other names 1

• US Renal Care Space City Dialysis LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

USRC Space City DialysisCCN 672859

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Jul 9, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

25

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

CLIA laboratory certificates

Part of

US Renal Care Inc

Member of 1

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

• Dialysis Newco LLC

  dba U.S. Renal Care Bryan Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bryan, TX
  • NPI 1578839080

  Member Of

  NPD member

Locations

Affiliated clinicians 3

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

• Mahendra Agraharkar, M.D.

  • Nephrology Physician
  • League City, TX
  • NPI 1194751297

  Dialysis facility

  Care Compare affiliation Name & address match
• Muhammad Ahmad Mujtaba, M.D.

  • Nephrology Physician
  • Webster, TX
  • NPI 1740426592

  Dialysis facility

  Care Compare affiliation Name & address match
• Daniel Sloan Rospert, MD

  • Nephrology Physician
  • Webster, TX
  • NPI 1407483688

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1487105920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251549",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750251500",
            "telephone_number": "214-736-2700",
            "fax_number": "214-736-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3402 BURKE RD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775041805",
            "telephone_number": "713-425-0428",
            "fax_number": "713-425-0427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE CITY DIALYSIS PASADENA - DSI, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "US RENAL CARE INC.",
        "enumeration_date": "2016-10-19",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "214-736-2700"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "US Renal Care Space City Dialysis LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Oct 19, 2016; 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.