NPIMap

Organization Active NPI

Mulgee Dialysis LLC

Doing business as Hawthorne Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hawthorne, CA
National Provider Identifier
1710229794
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
550002530 Issued in CA
Legal business name
MULGEE DIALYSIS LLC
Doing business as
Hawthorne Dialysis
Practice address
14204 Prairie Ave
Hawthorne, CA 90250-7908
Phone
(310) 349-1174
Fax
(310) 349-1903
NPI assigned
Mar 18, 2013
Last updated
Jan 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

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

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 550002530 CA Primary

Addresses

Primary practice location

14204 Prairie Ave
Hawthorne, CA 90250-7908

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
1710229794MedicaidCA

Other names 1

  • Hawthorne Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130806000083 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 3577705474 Practice locations: Hawthorne, CA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Hawthorne DialysisCCN 552744
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Jan 24, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
25

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2066966Hawthorne Dialysis14204 Prairie Ave, Hawthorne, CA 90250Certificate of waiverOct 6, 2027

National Provider Directory

National Provider Directory

Member of 1

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

Practitioners & affiliated clinicians

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.

Affiliated clinicians 6

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

NPI Registry JSON

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

{
    "created_epoch": "1363564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769385600000",
    "number": "1710229794",
    "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": "14204 PRAIRIE AVE",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902507908",
            "telephone_number": "310-349-1174",
            "fax_number": "310-349-1903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULGEE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-18",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "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": "CA",
            "license": "550002530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710229794",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hawthorne Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hawthorne Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hawthorne, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; 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.