Isd Renal Inc

Primary specialty

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

Legal business name

ISD RENAL INC

Doing business as

Lake Road Dialysis

Practice address

6902 SE Lake Rd
Ste 100
Milwaukie, OR 97267-2148

Phone

(503) 794-1288

Fax

(503) 794-5916

NPI assigned

May 25, 2006

Last updated

Aug 26, 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 identifiers 1

Other names 1

• Lake Road Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

DaVita Lake Road DialysisCCN 382534

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jul 9, 1999

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

21

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

CLIA laboratory certificates

Tax ID family

Renal Care of Marion88 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 2

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Isd Renal Inc

  dba Willamette Valley Renal Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Oregon City, OR
  • NPI 1023064474
  NPD tax ID
• Isd Renal Inc

  dba Cornell Road Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Beaverton, OR
  • NPI 1548552003
  NPD tax ID

Member of 2

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

• Dva Healthcare Renal Care Inc

  dba Central Bamberg Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bamberg, SC
  • NPI 1639131741

  Member Of

  NPD member
• Dva Renal Healthcare Inc

  dba Durham West Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Durham, NC
  • NPI 1275592602

  Member Of

  NPD member

All facility ownership & control disclosures 3

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

Affiliated clinicians 5

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

• Maria Theresa Silvano De Jesus, MD

  • Nephrology Physician
  • Portland, OR
  • NPI 1083825251

  Dialysis facility

  Care Compare affiliation Name & address match
• Tricia N Jesperson, DO

  • Nephrology Physician
  • Portland, OR
  • NPI 1174777973

  Dialysis facility

  Care Compare affiliation Name & address match
• Firas George Khoury, MD

  • Nephrology Physician
  • Tigard, OR
  • NPI 1013933480

  Dialysis facility

  Care Compare affiliation Name & address match
• Robert Whitney Rope, M.D.

  • Nephrology Physician
  • Portland, OR
  • NPI 1720377039

  Dialysis facility

  Care Compare affiliation Name & address match
• Micah Laurence Thorp, DO

  • Nephrology Physician
  • Milwaukie, OR
  • NPI 1912010893

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1700832318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: LICENSURE & CERTIFICATION",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6902 SE LAKE RD",
            "address_2": "STE 100",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972672148",
            "telephone_number": "503-794-1288",
            "fax_number": "503-794-5916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISD RENAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "170060",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Road Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Road Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Raquel Iglesias, OTR/L
• Integrated Health Clinics, LLC
• Amilina Natetiny Inthavong, LMT
• Matthew Pickens Irvine, PHYSICAL THERAPIST
• Karen Lee Irving, OTRL
• Mel E Iseminger, PT
• Adam D Isfeld, DC
• Adrienne Leigh Isgrigg, M.S.
• Carly Inga Itami, DOULA
• Sonan Daba Itcha, FNP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.