Fullerton Dialysis Center LLC

Primary specialty

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

License

550000051 Issued in CA

Legal business name

FULLERTON DIALYSIS CENTER LLC

Practice address

3214 Yorba Linda Blvd
Fullerton, CA 92831-1707

Phone

(714) 577-6940

Fax

(714) 577-0530

NPI assigned

Mar 28, 2006

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

• Crossroads Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Crossroads Dialysis CenterCCN 552544

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Jul 29, 2005

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

24

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.

• Renal Treatment Centers California Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Napa, CA
  • NPI 1366405748

  Member Of

  NPD member

Locations

Affiliated clinicians 1

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

• Sridhar Kadumpalli Reddy, M.D.

  • Nephrology Physician
  • Garden Grove, CA
  • NPI 1780835447

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1891756276",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3214 YORBA LINDA BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928311707",
            "telephone_number": "714-577-6940",
            "fax_number": "714-577-0530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "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": "CA",
            "license": "550000051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891756276",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crossroads Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Fullerton Counseling and Medical Group, Inc
• Fullerton Elementary School District
• Fullerton Eye Center Medical Group
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• Fullerton GYN Assoc.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fullerton, CA
• Providers in Fullerton, 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 Aug 12, 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.