Innovative Dialysis Centers of la Jolla LLC

Primary specialty

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

Legal business name

INNOVATIVE DIALYSIS CENTERS OF LA JOLLA LLC

Practice address

2084 Otay Lakes Rd
Ste 101-a
Chula Vista, CA 91915-1368

Phone

(619) 397-0262

Fax

(619) 482-6791

NPI assigned

Sep 18, 2013

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

Authorized Official

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other names 1

• U.S. Renal Care Chula Vista Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Innovative Dialysis Centers of la Jolla LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Chula Vista, CA
  • NPI 1982954871

  2668621822

  Same PAC ID

Listed as

USRC Chula Vista DialysisCCN 552762

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jul 23, 2014

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

15

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

Innovative Dialysis Centers of la Jolla LLC2 organizations share this tax ID, including this one

Part of

US Renal Care Inc

Other organizations with this tax ID 1

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

• Innovative Dialysis Centers of la Jolla LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Chula Vista, CA
  • NPI 1982954871
  NPD tax ID

Member of 1

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

• Roderick a Comunale II MD Inc

  • Nephrology Physician
  • National City, CA
  • NPI 1033172002

  Member Of

  NPD member

Locations

Practitioners 2

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

• Roderick A Comunale II, MD

  • Nephrology Physician
  • National City, CA
  • NPI 1568462109
  NPD (past)
• Ahmad Bilal, MD

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1609030345
  NPD (past)

Affiliated clinicians 2

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

• Roderick A Comunale II, MD

  • Nephrology Physician
  • National City, CA
  • NPI 1568462109

  Dialysis facility

  Care Compare affiliation Name & address match
• John S Videen, MD

  • Nephrology Physician
  • Chula Vista, CA
  • NPI 1043318199

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1379462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422835200000",
    "number": "1992131395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WORLD TRADE CTR STE 2500",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908312500",
            "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": "2084 OTAY LAKES RD",
            "address_2": "STE 101-A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919151368",
            "telephone_number": "619-397-0262",
            "fax_number": "619-482-6791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DIALYSIS CENTERS OF LA JOLLA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2013-09-18",
        "last_updated": "2015-02-02",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "U.S. Renal Care Chula Vista Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Chula Vista, CA
• Providers in Chula Vista, 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 Feb 2, 2015; 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.