SRS-San Diego LLC

Primary specialty

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

Legal business name

SRS-SAN DIEGO LLC

Practice address

963 Lane Ave
Chula Vista, CA 91914-3501

Phone

(855) 474-7365

Fax

(855) 631-0206

NPI assigned

Mar 16, 2020

Organization subpart

No

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

Authorized official

Name

Jerome Seymour Tannenbaum, MD, PHDNPI 1346485638

Title

Ceo

Phone

(615) 467-0140

Specialties & licenses 1

Addresses

Other names 1

• SRS-Chula Vista LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Sanderling Dialysis of Chula VistaCCN 752596

Overall star rating

1.0 of 5

Ownership

Profit

Certified

May 4, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

16

Locations

Practitioners 1

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

• Jerome Seymour Tannenbaum, M.D., PH.D.

  • Nephrology Physician
  • Nashville, TN
  • NPI 1346485638
  NPD (past) Authorized official

Affiliated clinicians 1

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

• Rakesh Malhotra, M.D., M.P.H.

  • Nephrology Physician
  • San Diego, CA
  • NPI 1326346818

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615334400000",
    "number": "1871129379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198813",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372198813",
            "telephone_number": "615-988-1060",
            "fax_number": "855-631-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "963 LANE AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919143501",
            "telephone_number": "855-474-7365",
            "fax_number": "855-631-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRS-SAN DIEGO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-16",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A",
        "authorized_official_last_name": "TANNENBAUM",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "SEYMOUR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-467-0140",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRS-Chula Vista LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SRS-Chula Vista LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Chula Vista, CA
• Providers in Chula Vista, 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 Mar 10, 2021; 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.