Aqua Dialysis San Augustine, LLC

Primary specialty

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

Legal business name

AQUA DIALYSIS SAN AUGUSTINE, LLC

Practice address

403 N Milam St
San Augustine, TX 75972-2228

Phone

(936) 275-3600

NPI assigned

Oct 23, 2020

Last updated

Sep 10, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

AQUA DIALYSIS LLPAs reported in NPPES

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

Authorized official

Name

Rupal Patel, MD

Title

Ceo

Phone

(832) 721-2927

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Aqua Dialysis San AugustineCCN 672689

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Mar 23, 2009

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Other

Dialysis stations

10

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

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Namrata Sharma Goel, M.D.

  • Nephrology Physician
  • Houston, TX
  • NPI 1497862247
  NPD (past)

Affiliated clinicians 2

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

• Muhammad Amjad Mir, DO

  • Nephrology Physician
  • Lufkin, TX
  • NPI 1912168501

  Dialysis facility

  Care Compare affiliation Name & address match
• Dolamu Olumide Bamidele Sokunbi, M.D.

  • Nephrology Physician
  • Nacogdoches, TX
  • NPI 1942276001

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1649879230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 SOUTHRIDGE CT STE 102",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760534390",
            "telephone_number": "682-429-4508",
            "fax_number": "346-214-6368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 N MILAM ST",
            "city": "SAN AUGUSTINE",
            "state": "TX",
            "postal_code": "759722228",
            "telephone_number": "936-275-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AQUA DIALYSIS SAN AUGUSTINE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AQUA DIALYSIS LLP",
        "enumeration_date": "2020-10-23",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RUPAL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "832-721-2927",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 902 E Main St Opco LLC (Avir at San Augustine)
• 902 E Main St TX15 Opco LLC (San Augustine Nursing and Rehab Center)
• Latasha Barnes
• Blake Barr
• Matthew Julian Bearden, LVN
• Bio-Medical Applications of Texas, Inc. (Fresenius Kidney Care San Augustine Dialysis Center)
• Lindsey Blackshear, COTA

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in San Augustine, TX
• Providers in San Augustine, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

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