Holten Dialysis LLC

Primary specialty

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

Legal business name

HOLTEN DIALYSIS LLC

Practice address

1800 Medical Center Dr
Ste 150
San Bernardino, CA 92411-1218

Phone

(909) 887-2717

Fax

(909) 887-3794

NPI assigned

Oct 14, 2015

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

• Serrano Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Serrano DialysisCCN 552830

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Apr 18, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

25

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

Locations

Affiliated clinicians 4

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

• Daniel Kyung Hwang, M.D.

  • Nephrology Physician
  • San Bernardino, CA
  • NPI 1629150081

  Dialysis facility

  Care Compare affiliation Name & address match
• Parag Mehtani, M.D.

  • Nephrology Physician
  • San Bernardino, CA
  • NPI 1770773160

  Dialysis facility

  Care Compare affiliation Name & address match
• Ashok Nath, M.D.,

  • Nephrology Physician
  • San Bernardino, CA
  • NPI 1992951115

  Dialysis facility

  Care Compare affiliation Name & address match
• James Patrick Tomas, MD

  • Nephrology Physician
  • San Bernardino, CA
  • NPI 1902040819

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1444780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1831560077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-238-3085",
            "fax_number": "800-268-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 MEDICAL CENTER DR",
            "address_2": "STE 150",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111218",
            "telephone_number": "909-887-2717",
            "fax_number": "909-887-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLTEN DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-14",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831560077",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Serrano Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Serrano Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vanessa D Holm, M.S., LMFT
• Brian Holman
• Jessie Brianna Marie Holston
• Glenn Edwin Holt, MD
• Shelley Holt
• Elaine Meara Holzer, MFT
• Jackelyn Hong, PHARM.D.
• Shannon Daniele Hooks, FAMILY NURSE PRACTIT
• Jacqueline Hooley
• Destiny Hooper

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in San Bernardino, CA
• Providers in San Bernardino, 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 Feb 28, 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.