NPIMap

Organization Active NPI

Isd Renal Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cookeville, TN
National Provider Identifier
1003390469
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
ISD RENAL INC
Practice address
1843 Foreman Dr Ste 201
Cookeville, TN 38501-5933
Phone
(931) 372-2706
Fax
(931) 372-8421
NPI assigned
Sep 21, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

1843 Foreman Dr Ste 201
Cookeville, TN 38501-5933

Mailing address

5200 Virginia Way
L&C Department
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
Q052745MedicaidTN

Other names 1

  • Foreman Drive Home Training Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190625003890 TN Part A Provider - End-Stage Renal Disease Facility (ESRD) 6507053790 Practice locations: Cookeville, TN

Other NPIs with the same Medicare PAC ID 24

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

  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Dyersburg, TN
    • NPI 1619459682

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Greensboro, GA
    • NPI 1073816914

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Philadelphia, PA
    • NPI 1134640949

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Indianapolis, IN
    • NPI 1174006662

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • North Providence, RI
    • NPI 1174579619

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Pennsauken, NJ
    • NPI 1194230441

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Bridgeport, OH
    • NPI 1205396744

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Philadelphia, PA
    • NPI 1235795204

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Englewood, NJ
    • NPI 1245891670

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Philadelphia, PA
    • NPI 1295344307

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Upper Darby, PA
    • NPI 1316540388

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Dayton, OH
    • NPI 1336682707

    6507053790

    Same PAC ID
View all 24

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Foreman Drive Home TrainingCCN 442758
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Aug 19, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
3

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 NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2155650Isd Renal Inc1843 Foreman Drive Suite 201, Cookeville, TN 38501Certificate of waiverOct 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Renal Care of Marion88 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 11

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Member of 1

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

Networks

  • AL HMO

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1537488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1003390469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1843 FOREMAN DR STE 201",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385015933",
            "telephone_number": "931-372-2706",
            "fax_number": "931-372-8421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISD RENAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-21",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "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": "Q052745",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foreman Drive Home Training",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Foreman Drive Home Training",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.