NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

Doing business as Victor Valley Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Apple Valley, CA
National Provider Identifier
1861467607
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
240000022 Issued in CA
Legal business name
DVA HEALTHCARE RENAL CARE INC
Doing business as
Victor Valley Dialysis
Practice address
16049 Kamana Rd
Apple Valley, CA 92307-1331
Phone
(760) 242-8311
Fax
(760) 242-5419
NPI assigned
Feb 22, 2006
Last updated
May 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
John D Winstel
Title
Chief Accounting Officer
Phone
(253) 733-4501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 240000022 CA Primary

Addresses

Primary practice location

16049 Kamana Rd
Apple Valley, CA 92307-1331

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 238-3085

Other identifiers 1

IdentifierTypeStateIssuer
1861467607MedicaidCA

Other names 1

  • Victor Valley Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030428000016 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 7517875545 Practice locations: Apple Valley, CA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Victor Valley DialysisCCN 052561
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Jul 30, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
22

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0573013Victor Valley Dialysis16049 Kamana Road, Apple Valley, CA 92307Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Community Dialysis Services194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Member of 1

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

Locations

16049 Kamana Rd
Apple Valley, CA 92307
Phone (760) 242-8311

Practitioners & affiliated clinicians

Affiliated clinicians 4

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

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1861467607",
    "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": "615-238-3085",
            "fax_number": "800-268-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16049 KAMANA RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071331",
            "telephone_number": "760-242-8311",
            "fax_number": "760-242-5419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "240000022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861467607",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victor Valley Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Victor Valley Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; 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.