End-Stage Renal Disease Dialysis Facility
Change of National Provider Identifier Application Packet
A dialysis clinic may be certified as an End-Stage Renal Disease (ESRD) facility in California. An ESRD facility is an entity that provides outpatient maintenance dialysis services, or home dialysis training and support services, or both, pursuant to Title 42 Code of Federal Regulations (CFR) section 494.10.
To report a Change of National Provider Identifier (NPI), you must complete the required application packet. Refer to Title 42 CFR 424.506 for information regarding NPI enrollment requirements.
How to Apply
An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The provider instructions are a resource to guide you through the process. The provider checklist identifies the required forms and supporting documents needed to apply for certification.
Please refer to the following links to get started:
Application Packet Forms
Where to Submit Applications
Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.
California Department of Public Health
Center for Health Care Quality
Centralized Applications Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377