Stockton Dialysis LLC

Primary specialty

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

Legal business name

STOCKTON DIALYSIS LLC

Doing business as

Moore Dialysis

Practice address

620 S Santa Fe Ave Ste C
Moore, OK 73160-2476

Phone

(405) 799-2439

Fax

(405) 799-2409

NPI assigned

Dec 17, 2014

Last updated

Jan 22, 2024By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Moore Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Listed as

DaVita Moore DialysisCCN 372603

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Aug 22, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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 2

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

• Total Renal Care Inc

  dba Cerritos Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cerritos, CA
  • NPI 1255681011

  Member Of

  NPD member
• Total Renal Care, Inc.

  dba Bountiful Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bountiful, UT
  • NPI 1184387516

  Member Of

  NPD member

Locations

Affiliated clinicians 4

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

• Kendral Raymon Knight, M.D.

  • Nephrology Physician
  • Norman, OK
  • NPI 1275783250

  Dialysis facility

  Care Compare affiliation Name & address match
• Cuong Dinh Nguyen, MD

  • Nephrology Physician
  • Norman, OK
  • NPI 1659497451

  Dialysis facility

  Care Compare affiliation Name & address match
• Dustin Shawn Tedesco, MD

  • Internal Medicine Physician
  • Norman, OK
  • NPI 1649476136

  Dialysis facility

  Care Compare affiliation Name & address match
• David Collier Williams, M.D.

  • Nephrology Physician
  • Norman, OK
  • NPI 1518991264

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1821496217",
    "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",
            "telephone_number": "615-320-4268",
            "fax_number": "877-238-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 S SANTA FE AVE STE C",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602476",
            "telephone_number": "405-799-2439",
            "fax_number": "405-799-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOCKTON DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-17",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200694610A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moore Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Moore Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jorja Stevenson, APRN-BC, PMHNP-BC
• Mikayla Stewart
• Sara Elizabeth Stewart, LPC CANDIDATE
• Alyssa Stiles
• Ariel Stilwell
• Courtney Strain
• Tonya Kay Stringer
• Teeia Strout, FNP
• Haley Harrison Strutton, DNP, APRN, FNP-C
• Nicole Stull

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Moore, OK
• Providers in Moore, OK by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.