SRS-la Mirada LLC

Primary specialty

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

Legal business name

SRS-LA MIRADA LLC

Practice address

14337 Imperial Hwy
La Mirada, CA 90638

Phone

(615) 988-7881

NPI assigned

Jun 26, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Jerome Tannenbaum, MDNPI 1346485638

Title

Ceo

Phone

(615) 467-0140

Specialties & licenses 1

Addresses

Other names 1

• SRS-LA MIRADA, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

End-stage renal disease facility certification: CCN 552882

Legal name

SRS- LA MIRADA

Certification status

Active

Provider type (POS)

End-stage renal disease facility

Participating since

Sep 4, 2019

Last certification

Jan 4, 2023

Ownership / control type

For Profit

Most recent change of ownership

Mar 1, 2024

Facility address

14337 Imperial Hwy
La Mirada, CA 90638

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerome Seymour Tannenbaum, M.D., PH.D.

  • Nephrology Physician
  • Nashville, TN
  • NPI 1346485638
  NPD (past) Authorized official

Affiliated clinicians 1

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

• Willy Singh, D.O.

  • Nephrology Physician
  • Whittier, CA
  • NPI 1265587075

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704067200000",
    "number": "1538845474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 HARDING PIKE",
            "address_2": "SUITE 205",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372052098",
            "telephone_number": "615-467-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14337 IMPERIAL HWY",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "90638",
            "telephone_number": "615-988-7881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRS-LA MIRADA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2024-01-01",
        "certification_date": "2024-01-01",
        "status": "A",
        "authorized_official_last_name": "TANNENBAUM",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-467-0140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRS-LA MIRADA, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in La Mirada, CA
• Providers in La Mirada, 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 Jan 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.