NPIMap

Organization Active NPI

300 S Robertson Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1962473025
Registry record updated Nov 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
930000915 Issued in CA
Legal business name
300 S ROBERTSON DIALYSIS, LLC
Practice address
300 S Robertson Blvd
Los Angeles, CA 90048-3806
Phone
(310) 385-8683
Fax
(310) 385-0516
NPI assigned
Jan 27, 2006
Organization subpart
Yes
Parent organization
U.S. RENAL CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2014

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

Authorized official

Name
Thomas L Weinberg
Title
Authorized Official
Phone
(214) 736-2700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 930000915 CA Primary

Addresses

Primary practice location

300 S Robertson Blvd
Los Angeles, CA 90048-3806

Mailing address

PO Box 749124
Los Angeles, CA 90074-9124
Phone (562) 495-8075

Other identifiers 1

IdentifierTypeStateIssuer
CDC02837GMedicaidCA

Other names 1

  • U.S. Renal Care Westside Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050926001122 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 0840224044 Practice locations: Los Angeles, CA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
USRC Westside DialysisCCN 052837
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Aug 19, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Chain
US Renal Care, Inc.
Dialysis stations
24

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
05D0962071300 S Robertson Dialysis, LLC300 South Robertson Boulevard, Los Angeles, CA 90048Certificate of waiverJun 22, 2027

National Provider Directory

National Provider Directory
Part of
US Renal Care Inc

Practitioners & affiliated clinicians

Practitioners 1

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

Affiliated clinicians 11

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": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415923200000",
    "number": "1962473025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749124",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900749124",
            "telephone_number": "562-495-8075",
            "fax_number": "562-495-8076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S ROBERTSON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900483806",
            "telephone_number": "310-385-8683",
            "fax_number": "310-385-0516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "300 S ROBERTSON DIALYSIS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2006-01-27",
        "last_updated": "2014-11-14",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "214-736-2700"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "930000915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CDC02837G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "U.S. Renal Care Westside Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; 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.