Bullards Dialysis LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Cameron Park, CA
NPI 1497030852 · NPPES record last updated Jun 9, 2026
Key facts
- NPI
- 1497030852
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 110000457 (CA)
- Legal business name
- BULLARDS DIALYSIS LLC
- Practice address
- 3311 Coach LN
Ste C
Cameron Park, CA 95682-7247 - Phone
- (530) 677-5114
- Fax
- (530) 677-5190
- NPI assigned
- Oct 18, 2011
- Organization subpart
- No
Authorized official
- Name
- Samuel T. Wey
- Title
- VP, Licensure & Certification
- Phone
- (615) 341-6641
Member of 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120208000970 | CA | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 3870750409 | Practice locations: Cameron Park, CA |
National Provider Directory
Locations
3311 Coach Ln
Ste C
Cameron Park, CA 95682
Phone (530) 677-5114
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 110000457 | CA | Yes |
Addresses
Primary practice location
3311 Coach LN
Ste C
Cameron Park, CA 95682-7247
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497030852 | Medicaid | CA |
Other names
- Cameron Park Dialysis
Other providers in Cameron Park, CA
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- Connie Kimble Burgeson
- Tamara Ann Cable
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- California Gastroenterology, a Medical Corporation
- Christine L. Cambridge
All providers in Cameron Park, CA · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.