Walcott Dialysis LLC

Primary specialty

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

License

550003126 Issued in CA

Legal business name

WALCOTT DIALYSIS LLC

Doing business as

Newport Irvine Dialysis

Practice address

4300 Von Karman Ave
Newport Beach, CA 92660-2004

Phone

(949) 863-1382

Fax

(949) 863-1407

NPI assigned

Jan 6, 2014

Last updated

Apr 24, 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 names 1

• Newport Irvine Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Newport Irvine DialysisCCN 552789

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Aug 17, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

17

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.

• Total Renal Care Inc

  dba Cerritos Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cerritos, CA
  • NPI 1255681011

  Member Of

  NPD member

Locations

Affiliated clinicians 6

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

• Jacob K Ahdoot, MD

  • Nephrology Physician
  • Irvine, CA
  • NPI 1952356214

  Dialysis facility

  Care Compare affiliation Name & address match
• Afsaneh Haftbaradaran Mohammadi, M.D.

  • Nephrology Physician
  • Fountain Valley, CA
  • NPI 1902040009

  Dialysis facility

  Care Compare affiliation Name & address match
• Ratnaja Katneni, MD

  • Nephrology Physician
  • Newport Beach, CA
  • NPI 1790887610

  Dialysis facility

  Care Compare affiliation Name & address match
• Azita Mesbah, MD

  • Nephrology Physician
  • Irvine, CA
  • NPI 1184670630

  Dialysis facility

  Care Compare affiliation Name & address match
• Paul Berj Ozuzun, M.D.

  • Nephrology Physician
  • Newport Beach, CA
  • NPI 1972868347

  Dialysis facility

  Care Compare affiliation Name & address match
• Eric Wechsler, M.D.

  • Nephrology Physician
  • Newport Beach, CA
  • NPI 1659469526

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1679995948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "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": "4300 VON KARMAN AVE",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602004",
            "telephone_number": "949-863-1382",
            "fax_number": "949-863-1407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALCOTT DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-06",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "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": "550003126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newport Irvine Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Newport Irvine Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea M Wagner, PSY.D.
• Austin Wagner, PHARMD
• Sabrina M Wahab
• Matthew Wai, DO
• Allison Marie Waite, M.A., LMFT
• Jamie Waldbaum
• Stephanie Waldman, MD
• Mykiyaa Marvella Walker-Sanchez
• Lorraine Annette Walker, M.D.
• Michael Owen Walker, PA

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Newport Beach, CA
• Providers in Newport Beach, 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 Apr 24, 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.