Roose Dialysis LLC

Primary specialty

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

License

550000652 Issued in CA

Legal business name

ROOSE DIALYSIS LLC

Doing business as

Stockton Kidney Center

Practice address

1523 E March LN
Ste 200
Stockton, CA 95210-5607

Phone

(209) 472-3300

Fax

(209) 472-0900

NPI assigned

Apr 20, 2009

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

• Stockton Kidney Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Stockton Kidney CenterCCN 552592

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Nov 28, 2007

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

20

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

CLIA laboratory certificates

Member of 1

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

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Affiliated clinicians 4

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

• Subrahmanyam Nasika, M.D.

  • Nephrology Physician
  • Stockton, CA
  • NPI 1548449846

  Dialysis facility

  Care Compare affiliation Name & address match
• Lan Ngoc Quang, M.D.

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1437354347

  Dialysis facility

  Care Compare affiliation Name & address match
• Ajay Kumar Rachakonda, MD

  • Nephrology Physician
  • Visalia, CA
  • NPI 1467605014

  Dialysis facility

  Care Compare affiliation Name & address match
• P B Sagireddy, MD

  • Nephrology Physician
  • Stockton, CA
  • NPI 1407844889

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1790929826",
    "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": "1523 E MARCH LN",
            "address_2": "STE 200",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952105607",
            "telephone_number": "209-472-3300",
            "fax_number": "209-472-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOSE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-20",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "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": "550000652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790929826",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stockton Kidney Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stockton Kidney Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ronald C. Allison M.D. Inc.
• Lillianna Rondaris
• Aaron Christopher Rondon, D.D.S., M.S.
• James D Rooke, M.D.
• Wendy Rooker
• Renisha Roots
• Alex Roque, PT
• Justice Roque
• James L Rore
• Pidara Rorn

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Stockton, CA
• Providers in Stockton, 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 Nov 20, 2024; 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.