Isd Renal Inc
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Robstown, TX
NPI 1790731784 · NPPES record last updated Jul 17, 2024
Key facts
- NPI
- 1790731784
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- ISD RENAL INC
- Practice address
- 3710 FM 1889
Robstown, TX 78380-5969 - Phone
- (361) 387-0289
- Fax
- (361) 387-0407
- NPI assigned
- May 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Samuel T Wey
- Title
- VP Licensure&Certification
- Phone
- (615) 341-6641
Corporate family (same tax ID) 8
Member of 1
Affiliated clinicians 6
-
Jack Locardi Cortese, M.D.
-
Shah Faizul Islam, M.D.
-
Karim N Nooruddin, M.D.
-
Geeta P Reddy, M.D.
-
William Lee Shaffer, M.D.
-
Fariba Zarinetchi, M.D.
Medicare Care Compare: Dialysis facility
- Listed as
- DaVita Riverside Renal Center
- Overall star rating
- ★★★☆☆ 3.0 of 5
- Ownership
- Profit
- Certified
- Feb 5, 1997
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 17
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0923744 | Riverside Renal Center | Certificate of waiver | Jan 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Carmel Health & Living Community |
Skilled nursing facility | Adp of the SNF | Jul 16, 2021 |
| Countryside Manor Health & Living Community |
Skilled nursing facility | Adp of the SNF | Jul 16, 2021 |
| Lincoln Hills of New Albany |
Skilled nursing facility | Adp of the SNF | Jul 16, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031105000184 | TX | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 9830100858 | Practice locations: Robstown, TX |
National Provider Directory
- Tax ID family
- Renal Care of Marion
Locations
3710 FM 1889
Robstown, TX 78380
Phone (361) 387-0289
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
3710 FM 1889
Robstown, TX 78380-5969
Mailing address
5200 Virginia Way
L&C Department
Brentwood, TN 37027-7569
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 188171602 | Medicaid | TX |
Other names
- Riverside Renal Center
Other providers in Robstown, TX
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- Ronald Holdorf
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- Donald Jackman
- Jkpjj Healthcare Systems, Inc.
- Joe E. Saenz Jr
- Juan Sygal, M.D., P.a.
- Alexis King
All providers in Robstown, TX · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.