At Home Dialysis, LLC

Primary specialty

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

Legal business name

AT HOME DIALYSIS, LLC

Practice address

340 E Commonwealth Ave
Fullerton, CA 92832-2017

Phone

(657) 500-8147

NPI assigned

Oct 12, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Gunda Jahromi

Title

Partner

Phone

(657) 500-8147

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

At Home Dialysis LLCCCN 752601

Ownership

Profit

Certified

Dec 18, 2023

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678838400000",
    "number": "1790401677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 E COMMONWEALTH AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928322017",
            "telephone_number": "657-500-8147",
            "fax_number": "866-735-9057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 E COMMONWEALTH AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928322017",
            "telephone_number": "657-500-8147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AT HOME DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A",
        "authorized_official_last_name": "JAHROMI",
        "authorized_official_first_name": "GUNDA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "657-500-8147",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gunda@statewideRE.net",
            "affiliation": "N",
            "endpointDescription": "direct email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "340 E Commonwealth Ave",
            "city": "Fullerton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928322017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fullerton, CA
• Providers in Fullerton, 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 Mar 15, 2023; 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.