Active NPI
Bridges Dialysis LLC
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Fort Wayne, IN
National Provider Identifier
1003119876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- BRIDGES DIALYSIS LLC
- Doing business as
- Fort Wayne South Dialysis
- Practice address
- 302 E Pettit Ave
Fort Wayne, IN 46806-3007 - Phone
- (260) 456-0451
- Fax
- (260) 458-9269
- NPI assigned
- Dec 16, 2010
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Primary |
Addresses
Primary practice location
302 E Pettit Ave
Fort Wayne, IN 46806-3007
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201048390A | Medicaid | IN |
Other names 1
- Fort Wayne South Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110302000417 | IN | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 5890976450 | Practice locations: Fort Wayne, IN |
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Fort Wayne, IN
- NPI 1093012544
5890976450
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Fort Wayne, IN
- NPI 1366745630
5890976450
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Fort Wayne, IN
- NPI 1558635276
5890976450
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita Fort Wayne South
- Overall star rating
- Ownership
- Profit
- Certified
- Oct 12, 2011
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 20
Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2022385 | Fort Wayne South Dialysis | Certificate of waiver | Mar 31, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Bridges Dialysis LLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Fort Wayne, IN
- NPI 1093012544
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Fort Wayne, IN
- NPI 1366745630
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Fort Wayne, IN
- NPI 1558635276
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
- Nephrology Physician
- Fort Wayne, IN
- NPI 1578505814
Member Of
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Burlington, WA
- NPI 1932595584
Member Of
Locations
302 E Pettit Ave
Fort Wayne, IN 46806
Phone (260) 456-0451
Networks
- OH PPO
Practitioners & affiliated clinicians
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292457600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1787616000000",
"number": "1003119876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5200 VIRGINIA WAY",
"address_2": "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": "302 E PETTIT AVE",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468063007",
"telephone_number": "260-456-0451",
"fax_number": "260-458-9269"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRIDGES DIALYSIS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-12-16",
"last_updated": "2026-08-25",
"certification_date": "2026-08-25",
"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": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201048390A",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Fort Wayne South Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Fort Wayne South Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; 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.