Portola Dialysis LLC

Primary specialty

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

Legal business name

PORTOLA DIALYSIS LLC

Doing business as

Mid Valley PD Home Training

Practice address

1205 N Michigan Ave
Saginaw, MI 48602-4729

Phone

(989) 771-9381

Fax

(989) 771-9407

NPI assigned

Aug 17, 2016

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Mid Valley PD Home Training Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Portola Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saginaw, MI
  • NPI 1841597689

  2860670866

  Same PAC ID

Listed as

DaVita Mid Valley Pd Home TrainingCCN 232717

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Dec 28, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

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

CLIA laboratory certificates

Tax ID family

Davita Mid Valley PD Home Training2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Portola Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saginaw, MI
  • NPI 1841597689
  NPD tax ID

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Ann Schauss, R.D., L.D.

  • Registered Dietitian
  • Lebanon, NH
  • NPI 1417188400
  NPD (past)

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595980800000",
    "number": "1861947020",
    "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": "615-320-4514",
            "fax_number": "866-594-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 N MICHIGAN AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486024729",
            "telephone_number": "989-771-9381",
            "fax_number": "989-771-9407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTOLA DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-17",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861947020",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Valley PD Home Training",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mid Valley PD Home Training",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aida B. Ponce, M.D.
• Jarryn Rose Pool
• Peggy Port
• Jill K Porter
• Portola Dialysis LLC
• Patricia Posey, MA., LLPC
• Possibility Transportation LLC
• Meredith A Post
• Tracie Ilene Potis, MD
• Jon Anthony Potrykus, DIPL.,AC.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Saginaw, MI
• Providers in Saginaw, MI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; 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.