NPIMap

Organization Active NPI

Dialysis Clinic Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Bragg, CA
National Provider Identifier
1700807708
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DIALYSIS CLINIC INC.
Practice address
512 Cypress St
Fort Bragg, CA 95437-5410
Phone
(707) 964-1610
Fax
(707) 964-1609
NPI assigned
Jul 22, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Donovan Schultz
Title
President
Phone
(615) 327-3061

Corporate family (same tax ID) 8

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

Affiliated clinicians 1

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Fort Bragg Dialysis DciCCN 552566
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Nov 15, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Dialysis Clinic, Inc.
Dialysis stations
10

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

All facility ownership & control disclosures 1

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rancho Dialysis ClinicSacramento, CA, CCN 552519 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 24, 2003
Dec 24, 2003

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20060504000461 CA Part a Provider - End-Stage Renal Disease Facility (ESRD) 4284541129 Practice locations: Fort Bragg, CA

National Provider Directory

National Provider Directory
Tax ID family
Elbert P Tuttle Jr MD (238 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

NPPES NPI Registry

Primary practice location

512 Cypress St
Fort Bragg, CA 95437-5410

Mailing address

180 Northpoint Dr
Redding, CA 96003-2510
Phone (530) 246-1140

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
CDC52566FMedicaidCA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 5, 2023.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1700807708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 NORTHPOINT DR",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960032510",
            "telephone_number": "530-246-1140",
            "fax_number": "530-246-1128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 CYPRESS ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375410",
            "telephone_number": "707-964-1610",
            "fax_number": "707-964-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DONOVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-327-3061",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "CDC52566F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Bragg, CA

Sources for this page

Verify at the official NPI Registry.