TULLY ROAD HOME TRAINING
NPI 1538400239
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in San Jose, CA

Q: What is Ponca Dialysis LLC's NPI number?

The NPI number for Ponca Dialysis LLC is 1538400239. It was assigned to this organization in the NPPES registry on March 6, 2013. The provider is doing business as Tully Road Home Training.

Q: What is Ponca Dialysis LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Active since March 06, 2013CLIA 05D2063037 · Waiver

1290 TULLY RD, STE 60, SAN JOSE, CA 95122(408) 275-0105(408) 275-0115 Get Directions Write a Review

NPPES record last updated: March 29, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 28, 2020, Jul 10, 2019 (2 updates tracked since 2019).

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About Tully Road Home Training NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TULLY ROAD HOME TRAINING (NPI 1538400239) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in San Jose, California and active in the NPI registry since March 2013. The organization holds a CLIA Waiver certificate valid through July 24, 2027 and lists Samuel Wey, Vp Licensure & Certification, as its authorized official.

NPPES Registry Identity

NPI1538400239

Entity TypeOrganization

Primary Taxonomy261QE0700X

Legal Business NamePONCA DIALYSIS LLC

Location Address1290 TULLY RD, STE 60San Jose, CA 95122-3069

Mailing Address5200 Virginia Way, L&c DeptBrentwood, TN 37027-7569

Phone(408) 275-0105

Fax(408) 275-0115

Organization SubpartNo

Authorized OfficialSamuel WeyVp Licensure & Certification · (615) 341-6641

Enumeration DateMarch 6, 2013

Last NPPES UpdateMarch 29, 20242 updates tracked since enumeration

NPPES CertifiedMarch 29, 2024

✔ NPI 1538400239 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities

Taxonomy Code261QE0700X

1290 TULLY RD, San Jose, CA 95122

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Other Names 1

Doing Business AsTully Road Home Training

Other Identifiers 1

Medicaid1538400239CA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2063037

Tully Road Home Training · San Jose, CA

Active · expires Jul 24, 2027

CLIA Number05D2063037

Laboratory TypeEnd Stage Renal Disease Dialysis Facility

Certificate Effective DateJuly 25, 2025

Certificate Expiration DateJuly 24, 2027

Laboratory DirectorPhilip Tse

Laboratory Phone(626) 960-9404

Laboratory LocationTully Road Home Training1290 Tully Rd Ste 60, San Jose, CA 95122

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Dialysis Facility Quality Ratings CMS Care Compare

Quality ratings, services and patient survey results for DaVita Tully Road Home Training PD (CMS certification number 552731), from CMS Care Compare.

DaVita Tully Road Home Training PD

Dialysis facility · San Jose, CA

OwnershipProfit

ChainDaVita

CMS Certification Number552731

ESRD NetworkNetwork 17

Medicare-Certified SinceSeptember 30, 2013

Location1290 TULLY RD SUITE 60San Jose, CA 95122 · Santa Clara County

Phone(408) 275-0105

Services Offered

Peritoneal dialysis Home hemodialysis training

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TOTAL RENAL CARE INC

Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)

1290 TULLY RD, STE 80
SAN JOSE, CA 95122

Santa Clara County (408) 993-8959

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ponca Dialysis LLC's NPI number?

The NPI number for Ponca Dialysis LLC is 1538400239. It was assigned to this organization in the NPPES registry on March 6, 2013. The provider is doing business as Tully Road Home Training.

Where is Ponca Dialysis LLC located?

Ponca Dialysis LLC is located at 1290 Tully Rd Ste 60, San Jose, CA 95122. The listed phone number is (408) 275-0105.

What is Ponca Dialysis LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Does Ponca Dialysis LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2063037) is associated with this NPI, valid through July 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Ponca Dialysis LLC a Medicare-certified dialysis facility?

Yes. DaVita Tully Road Home Training PD is a Medicare-certified dialysis facility, certified since September 30, 2013.

What insurance does Ponca Dialysis LLC accept?

Health plans from UnitedHealthcare list Ponca Dialysis LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ponca Dialysis LLC was last updated on March 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.