Lassen Dialysis LLC

Primary specialty

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

Legal business name

LASSEN DIALYSIS LLC

Practice address

18236 Fort St
Riverview, MI 48193-7439

Phone

(734) 283-4513

Fax

(734) 283-4570

NPI assigned

Jul 6, 2012

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

• Riverview Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Lassen Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dearborn, MI
  • NPI 1801215959

  3870741721

  Same PAC ID
• Lassen Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dearborn, MI
  • NPI 1619386489

  3870741721

  Same PAC ID

Listed as

DaVita Riverview DialysisCCN 232686

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Jan 24, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

22

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

CLIA laboratory certificates

Tax ID family

Corewell Health Dearborn Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Dva Healthcare Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dearborn, MI
  • NPI 1689833956
  NPD tax ID
• Lassen Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dearborn, MI
  • NPI 1801215959
  NPD tax ID
• Lassen Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dearborn, MI
  • NPI 1619386489
  NPD tax ID
• Oakwood Healthcare Inc

  • Internal Medicine Physician
  • Dearborn, MI
  • NPI 1821310806
  NPD tax ID

Member of 1

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

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Locations

Affiliated clinicians 1

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

• Sudheer R Ummadi, MD

  • Nephrology Physician
  • Allen Park, MI
  • NPI 1437118106

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736467200000",
    "number": "1497010474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18236 FORT ST",
            "city": "RIVERVIEW",
            "state": "MI",
            "postal_code": "481937439",
            "telephone_number": "734-283-4513",
            "fax_number": "734-283-4570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASSEN DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-06",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-08",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497010474",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverview Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Riverview Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Kreklau, BCBA
• Kristen Miller, D.D.S, P.L.L.C.
• Monica Kumar
• L & B Optical Inc
• Richard P. Laskowski, D O
• Alicia Lawyer, M.A-CF-SLP
• Autumn Elizabeth Lenart, LMT
• Ameur Limmitt
• Carly Lisinski, M.A, CF- SLP
• Marjorie Ann Lorenzon, MASSAGE THERAPIST

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Riverview, MI
• Providers in Riverview, MI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.