Elk Grove Dialysis Center LLC

Primary specialty

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

License

110000518 Issued in CA

Legal business name

ELK GROVE DIALYSIS CENTER LLC

Doing business as

Elk Grove Dialysis

Practice address

9281 Office Park Cir
Ste 105
Elk Grove, CA 95758-8069

Phone

(916) 691-0480

Fax

(916) 691-0488

NPI assigned

Mar 23, 2006

Last updated

Dec 10, 2024By 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 identifiers 1

Other names 1

• Elk Grove Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Elk Grove DialysisCCN 552529

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jul 30, 2004

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

21

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

CLIA laboratory certificates

Member of 1

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

• Renal Treatment Centers California Inc

  dba Napa Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Napa, CA
  • NPI 1366405748

  Member Of

  NPD member

Affiliated clinicians 2

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

• David Pai, MD

  • Nephrology Physician
  • Sacramento, CA
  • NPI 1023190808

  Dialysis facility

  Care Compare affiliation Name & address match
• Ushir V Patel, M.D.

  • Nephrology Physician
  • Sacramento, CA
  • NPI 1285936757

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1568421865",
    "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": "9281 OFFICE PARK CIR",
            "address_2": "STE 105",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957588069",
            "telephone_number": "916-691-0480",
            "fax_number": "916-691-0488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK GROVE DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "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": "110000518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568421865",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elk Grove Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elk Grove Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Trinity Eli
• Miriam Nelly Eliakim, RN
• Nikhat Amjad Elias
• John J Eliopulos, O.D.
• Elite Transit Inc
• Elk Grove Family Physicians Medical Group Inc
• Elk Grove Foot and Ankle PC
• Elk Grove Hearing Care
• Elk Grove Hearing Clinic, Inc. (Elk Grove Hearing Care)
• Elk Grove Home Health Inc (Elk Grove Home Health)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Elk Grove, CA
• Providers in Elk Grove, 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 Dec 10, 2024; 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.