NPIMap

Organization Active NPI

Llano Dialysis LLC

Doing business as San Pablo Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Pablo, CA
National Provider Identifier
1790912970
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
140000209 Issued in CA
Legal business name
LLANO DIALYSIS LLC
Doing business as
San Pablo Dialysis
Practice address
14020 San Pablo Ave
San Pablo, CA 94806-3604
Phone
(510) 234-0835
Fax
(510) 234-3854
NPI assigned
Jun 16, 2009
Last updated
Aug 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Authorized official

Name
Samuel Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 140000209 CA Primary

Addresses

Primary practice location

14020 San Pablo Ave
San Pablo, CA 94806-3604

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1790912970MedicaidCA

Other names 1

  • San Pablo Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090810000333 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9537211131 Practice locations: San Pablo, CA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • Llano Dialysis LLC

    dba El Cerrito Dialysis

    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • El Cerrito, CA
    • NPI 1063649242

    9537211131

    Same PAC ID
  • Llano Dialysis LLC

    dba Vallejo Dialysis

    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Vallejo, CA
    • NPI 1265669444

    9537211131

    Same PAC ID
  • Llano Dialysis LLC

    dba Oakland Peritoneal Dialysis Center

    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Oakland, CA
    • NPI 1568699882

    9537211131

    Same PAC ID

National Provider Directory

National Provider Directory
Tax ID family
Llano Dialysis LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member of 2

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

NPI Registry JSON

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1790912970",
    "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": "14020 SAN PABLO AVE",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948063604",
            "telephone_number": "510-234-0835",
            "fax_number": "510-234-3854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LLANO DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-16",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": "140000209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790912970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Pablo Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Pablo Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Pablo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.