NPIMap

Organization Active NPI

Renal Treatment Centers California Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Bernardino, CA
National Provider Identifier
1902869357
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
240000530 Issued in CA
Legal business name
RENAL TREATMENT CENTERS CALIFORNIA INC
Practice address
4041 University Pkwy
San Bernardino, CA 92407-1823
Phone
(909) 887-0173
Fax
(909) 887-2892
NPI assigned
Apr 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 240000530 CA Primary

Addresses

Primary practice location

4041 University Pkwy
San Bernardino, CA 92407-1823

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
1902869357MedicaidCA

Other names 1

  • Mountain Vista Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426000854 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 1951218858 Practice locations: San Bernardino, CA

Other NPIs with the same Medicare PAC ID 20

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

View all 20

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Mountain Vista Dialysis CenterCCN 052743
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Jan 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
28

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
05D0921089Mountain Vista Dialysis Center4041 University Pkwy, San Bernardino, CA 92407Certificate of waiverOct 17, 2026

National Provider Directory

National Provider Directory
Tax ID family
Renal Treatment Centers California Inc23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1902869357",
    "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": "4041 UNIVERSITY PKWY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924071823",
            "telephone_number": "909-887-0173",
            "fax_number": "909-887-2892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS CALIFORNIA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "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": "240000530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902869357",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Vista Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain Vista Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • 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.