Borrego Dialysis LLC

Primary specialty

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

Legal business name

BORREGO DIALYSIS LLC

Doing business as

Harrison Dialysis

Practice address

10475 Harrison Ave
Harrison, OH 45030-1941

Phone

(513) 202-0373

Fax

(513) 202-0819

NPI assigned

Feb 21, 2013

Last updated

Nov 21, 2024By the provider in NPPES

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

• Harrison Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

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

• Borrego Dialysis LLC

  dba West Hamilton Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hamilton, OH
  • NPI 1184038903

  3476791815

  Same PAC ID
• Borrego Dialysis LLC

  dba Western Ridge Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cincinnati, OH
  • NPI 1881050292

  3476791815

  Same PAC ID

Listed as

DaVita Harrison DialysisCCN 362806

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jan 22, 2014

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

13

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

CLIA laboratory certificates

Tax ID family

Borrego Dialysis LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Borrego Dialysis LLC

  dba West Hamilton Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hamilton, OH
  • NPI 1184038903
  NPD tax ID
• Borrego Dialysis LLC

  dba Western Ridge Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cincinnati, OH
  • NPI 1881050292
  NPD tax ID

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Mermet Dialysis LLC

  dba Affinity Place Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cincinnati, OH
  • NPI 1003236357

  Member Of

  NPD member
• The Good Samaritan Hospital of Cincinnati, Ohio

  dba Good Samaritan Surgery Center West

  • General Acute Care Hospital
  • Cincinnati, OH
  • NPI 1457964041

  Member Of

  NPD member
• Total Renal Care Inc

  dba Cerritos Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cerritos, CA
  • NPI 1255681011

  Member Of

  NPD member

Affiliated clinicians 2

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

• John Hergenrother, M.D.

  • Nephrology Physician
  • Cincinnati, OH
  • NPI 1073557500

  Dialysis facility

  Care Compare affiliation Name & address match
• Amit Kumar Rajput, M.D.

  • Nephrology Physician
  • Middletown, OH
  • NPI 1457614182

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1972843316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "10475 HARRISON AVE",
            "city": "HARRISON",
            "state": "OH",
            "postal_code": "450301941",
            "telephone_number": "513-202-0373",
            "fax_number": "513-202-0819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BORREGO DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-21",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-19",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100194",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harrison Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cassidy Bischoff, M.A. CCC-SLP
• Gregory Alen Blake Jr., MSN, APRN, FNP-BC
• Jazmin C. Blankman, O.D.
• Jane A Blinzler, MD
• Elizabeth Feldhaus Boettcher, RN
• Audrey Bray
• Rebecca Brehm-Smith, M.ED
• James E. Breidenstein, D.O.
• Michael P Brock, DPM
• Robin L Brock, LISW

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Harrison, OH
• Providers in Harrison, OH by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.