Havanna Dialysis LLC

Primary specialty

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

Legal business name

HAVANNA DIALYSIS LLC

Doing business as

Gaithersburg Dialysis

Practice address

202 Perry Pkwy Ste 3
Gaithersburg, MD 20877-2172

Phone

(301) 987-0912

Fax

(301) 947-6115

NPI assigned

Aug 15, 2017

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Gaithersburg Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Listed as

DaVita Gaithersburg DialysisCCN 212728

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Feb 2, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

16

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

CLIA laboratory certificates

Member of 1

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

• Renal Treatment Centers Mid Atlantic Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Goldsboro, NC
  • NPI 1174086698

  Member Of

  NPD member

Locations

Affiliated clinicians 1

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

• Vrinda Mahajan, M.D.

  • Internal Medicine Physician
  • St Louis, MO
  • NPI 1790997724

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763337600000",
    "number": "1013433713",
    "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": "202 PERRY PKWY STE 3",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772172",
            "telephone_number": "301-987-0912",
            "fax_number": "301-947-6115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVANNA DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-15",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "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": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6600131",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gaithersburg Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samantha Hartage
• Mubarak Ali Mubarak Hassan, M.D.
• Tehzeeb Hassan, DDS
• Eftekhar Alsadat Hassani, D.D.S
• Changting Haudenschild, M.D.
• Haiyan Shi Hawkes, LAC,, C.M.D.
• Hayat Nutrition & Wellness, LLC
• Nosheen Hayat, RDN
• Savana Hayes
• Tabatha Hayes

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Gaithersburg, MD
• Providers in Gaithersburg, MD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; 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.