Usrc Los Banos Home, LLC

Primary specialty

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

Legal business name

USRC LOS BANOS HOME, LLC

Practice address

1451 W Pacheco Blvd Ste G
Los Banos, CA 93635-8613

Phone

(209) 774-4211

Fax

(209) 774-4251

NPI assigned

Jun 13, 2023

Organization subpart

Yes

Parent organization

U.S. RENAL CARE, INC.As reported in NPPES

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

Authorized official

Name

Thomas L Weinberg

Title

Chairman/President

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other names 1

• U.S. Renal Care Los Banos Home Program Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

USRC Los Banos HomeCCN 752611

Ownership

Profit

Certified

May 1, 2024

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

1

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

CLIA laboratory certificates

Part of

US Renal Care Inc

Locations

Affiliated clinicians 1

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

• Atul T. Roy, M.D.

  • Nephrology Physician
  • Merced, CA
  • NPI 1467496505

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1686614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686614400000",
    "number": "1972287605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251549",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750251500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 W PACHECO BLVD STE G",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936358613",
            "telephone_number": "209-774-4211",
            "fax_number": "209-774-4251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USRC LOS BANOS HOME, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2023-06-13",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHAIRMAN/PRESIDENT",
        "authorized_official_telephone_number": "214-736-2700"
    },
    "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": "U.S. Renal Care Los Banos Home Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Trinity Medical Group Inc
• Truehealthcare
• Madison Trujillo
• Tiffany Tyler, PHARM D
• Madeleine Udonta, PHARM. D
• Raven Valenzuela
• Brande Gwen Van Brocklin, M.A. CCC-SLP
• Sonia Vasconcelos, LVN
• Kandice Vasquez
• Dasaratha Vemireddy, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Los Banos, CA
• Providers in Los Banos, 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 Jun 13, 2023; 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.