SRS-Payson, LLC

Primary specialty

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

Legal business name

SRS-PAYSON, LLC

Practice address

15 S 1000 E
Payson, UT 84651-5590

Phone

(888) 883-6407

Fax

(855) 631-0206

NPI assigned

May 20, 2021

Organization subpart

No

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

Authorized official

Name

Jerome Tannenbaum, MD

Title

Ceo and Chairman of the Board

Phone

(615) 467-0140

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Listed as

462543 SRS- Payson, LLCCCN 462543

Overall star rating

2.0 of 5

Ownership

Non-profit

Certified

Nov 19, 2009

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

12

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

CLIA laboratory certificates

Locations

Affiliated clinicians 1

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

• Robert Brown Woolley, MD

  • Nephrology Physician
  • Provo, UT
  • NPI 1104995109

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1548835879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198813",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372198813",
            "telephone_number": "615-988-1060",
            "fax_number": "855-631-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S 1000 E",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846515590",
            "telephone_number": "888-883-6407",
            "fax_number": "855-631-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRS-PAYSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "TANNENBAUM",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "CEO AND CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "615-467-0140",
        "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": []
}

• Jacob Dylan Sorenson
• South County Psychiatric Clinic Inc
• South Payson Medical Clinic
• South Valley Physical Therapy Inc.
• Southwestern Obstetrics & Gynecology P C
• Ashley Bophany Steadman, CRNA
• Steps Recovery Center
• Steps Recovery Center Daytreatment
• Steps Recovery Center St. George
• Steps Recovery Centers

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Payson, UT
• Providers in Payson, UT by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; 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.