Bullards Dialysis LLC

Primary specialty

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

License

110000457 Issued in CA

Legal business name

BULLARDS DIALYSIS LLC

Doing business as

Cameron Park Dialysis

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

Last updated

Jun 9, 2026By 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 names 1

• Cameron Park Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Member of 2

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

• Total Renal Care Inc

  dba Emporia Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Emporia, KS
  • NPI 1033528708

  Member Of

  NPD member
• Total Renal Care Inc

  dba Miller County Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Texarkana, AR
  • NPI 1083984082

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780963200000",
    "number": "1497030852",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3311 COACH LN",
            "address_2": "STE C",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956827247",
            "telephone_number": "530-677-5114",
            "fax_number": "530-677-5190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULLARDS DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-18",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "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": "CA",
            "license": "110000457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cameron Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cameron Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Oksana Boyechko, D.M.D.
• Brar Dental Group Inc
• Cloe Jean Brown, BS
• Jennifer Arlene Brown, LM
• Anne Katherine Bucon, LCSW
• Connie Kimble Burgeson, MD
• Tamara Ann Cable
• Nicole Cain, AMFT
• California Gastroenterology, a Medical Corporation
• Christine L. Cambridge, MD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Cameron Park, CA
• Providers in Cameron Park, CA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.