Lassen Dialysis, LLC

Primary specialty

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

Legal business name

LASSEN DIALYSIS, LLC

Doing business as

Dearborn Home Dialysis

Practice address

22030 Park St
Dearborn, MI 48124-2854

Phone

(313) 792-7343

Fax

(313) 792-8341

NPI assigned

Aug 6, 2014

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

• Dearborn Home Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Lassen Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Riverview, MI
  • NPI 1497010474

  3870741721

  Same PAC ID
• Lassen Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dearborn, MI
  • NPI 1801215959

  3870741721

  Same PAC ID

Tax ID family

Corewell Health Dearborn Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Dva Healthcare Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dearborn, MI
  • NPI 1689833956
  NPD tax ID
• Lassen Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Riverview, MI
  • NPI 1497010474
  NPD tax ID
• Lassen Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dearborn, MI
  • NPI 1801215959
  NPD tax ID
• Oakwood Healthcare Inc

  • Internal Medicine Physician
  • Dearborn, MI
  • NPI 1821310806
  NPD tax ID

Member of 1

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

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

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

{
    "created_epoch": "1407283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1619386489",
    "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": "22030 PARK ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242854",
            "telephone_number": "313-792-7343",
            "fax_number": "313-792-8341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASSEN DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-06",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619686489",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dearborn Home Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Nicole Laroy
• Jose Ramil Lasala, ACNP-BC
• Lasik Centers of Michigan PC
• Marilyn Lasovage, M.D.
• Lassen Dialysis LLC
• Sydney Lassen, PA-C
• Stephanie Latka, LLPC
• Lawrence G Morawa MD PC
• Lawrence S Mintzer DDS PLLC
• China Lawson

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Dearborn, MI
• Providers in Dearborn, MI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.