Lighthouse Dialysis LLC

Primary specialty

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

License

550001590 Issued in CA

Legal business name

LIGHTHOUSE DIALYSIS LLC

Practice address

1345 W Bush St
Lemoore, CA 93245-3303

Phone

(559) 924-3175

Fax

(559) 924-2485

NPI assigned

Jan 12, 2011

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

Sr Dir Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lemoore Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Lemoore DialysisCCN 552679

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jun 30, 2011

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

16

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 4

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

• Hanford Community Hospital

  • General Acute Care Hospital
  • Hanford, CA
  • NPI 1538141627

  Member Of

  NPD member
• Thong DO, M.D., Inc.

  • Nephrology Physician
  • Hanford, CA
  • NPI 1285938506

  Member Of

  NPD member
• Tom Yang MD Inc

  • Nephrology Physician
  • Visalia, CA
  • NPI 1417101908

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Napa, CA
  • NPI 1295024206

  Member Of

  NPD member

Locations

Affiliated clinicians 3

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

• Dhayanithi Dhayalan, MD

  • Nephrology Physician
  • Fresno, CA
  • NPI 1124513312

  Dialysis facility

  Care Compare affiliation Name & address match
• Thong Huy DO, M.D.

  • Nephrology Physician
  • Hanford, CA
  • NPI 1437369303

  Dialysis facility

  Care Compare affiliation Name & address match
• Tom Yang, M.D.

  • Nephrology Physician
  • Visalia, CA
  • NPI 1548346695

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1294790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694390400000",
    "number": "1639474265",
    "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",
            "telephone_number": "615-238-3085",
            "fax_number": "800-268-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 W BUSH ST",
            "city": "LEMOORE",
            "state": "CA",
            "postal_code": "932453303",
            "telephone_number": "559-924-3175",
            "fax_number": "559-924-2485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-12",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR DIR 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": "550001590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639474265",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lemoore Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lemoore Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lemoore Union Elementary School District
• Juvenal T Leon
• Michael Kelly Leoni, MD
• Aisha Lewis
• Jeanne Liburdi
• Lighthouse Physical Therapy P.C.
• Lily of the Valley Emmanuel Church of Jesus Christ
• Ridwan Lingga
• Jesse R Liscomb Jr., M.D.
• Mathew Robert Loe, NP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Lemoore, CA
• Providers in Lemoore, 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 Sep 11, 2023; 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.