Spalding County Dialysis, LLC

Primary specialty

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

License

ESRD001194 Issued in GA

Legal business name

SPALDING COUNTY DIALYSIS, LLC

Practice address

744 S 8TH St Ste 100
Griffin, GA 30224-4827

Phone

(770) 467-8116

Fax

(770) 467-8795

NPI assigned

Jun 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mohamad Moussa Kassem, MDNPI 1891726121

Title

President

Phone

(770) 467-8116

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Spalding County DialysisCCN 112696

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Oct 3, 2001

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

20

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

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohamad M Kassem, M.D.

  • Nephrology Physician
  • Stockbridge, GA
  • NPI 1891726121
  NPD (past) Authorized official
• Fahad Khan, MD

  • Nephrology Physician
  • Stockbridge, GA
  • NPI 1073742029
  NPD (past)
• Chadi Obeid, MD

  • Nephrology Physician
  • Stockbridge, GA
  • NPI 1346470226
  NPD (past)

Affiliated clinicians 1

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

• Mohamad M Kassem, M.D.

  • Nephrology Physician
  • Stockbridge, GA
  • NPI 1891726121

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701388800000",
    "number": "1023058898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 S 8TH ST STE 100",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244827",
            "telephone_number": "770-467-8116",
            "fax_number": "770-467-8795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 S 8TH ST STE 100",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244827",
            "telephone_number": "770-467-8116",
            "fax_number": "770-467-8795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPALDING COUNTY DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A",
        "authorized_official_last_name": "KASSEM",
        "authorized_official_first_name": "MOHAMAD",
        "authorized_official_middle_name": "MOUSSA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-467-8116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD001194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00946613A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Spalding County Board of Health
• Spalding County Board of Health
• Spalding Endoscopy Center, LLC
• Spalding Medical Products
• Spalding Post Acute LLC
• Spalding Regional OB-GYN, LLC
• Spalding Regional Physician Services, LLC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Griffin, GA
• Providers in Griffin, GA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.