NPIMap

Organization Active NPI

Dva Healthcare of Maryland LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Frederick, MD
National Provider Identifier
1023078466
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E2598 Issued in MD
Legal business name
DVA HEALTHCARE OF MARYLAND LLC
Practice address
140 Thomas Johnson Dr
Ste 100
Frederick, MD 21702-4475
Phone
(301) 695-0900
Fax
(301) 695-2808
NPI assigned
Mar 27, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Samuel T Wey
Title
VP, Licensure & Certification
Phone
(615) 341-6641

Other NPIs with the same Medicare PAC ID 7

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

Member of 1

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

Affiliated clinicians 3

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Frederick DialysisCCN 212598
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Jan 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
27

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
21D0859435Frederick Dialysis140 Thomas Johnson Drive #100, Frederick, MD 21702Certificate of waiverAug 31, 2026

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050311000157 MD Part A Provider - End-Stage Renal Disease Facility (ESRD) 8426968256 Practice locations: Frederick, MD

National Provider Directory

National Provider Directory
Tax ID family
Dva Healthcare of Maryland LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

140 Thomas Johnson Dr
Ste 100
Frederick, MD 21702
Phone (301) 695-0900

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X E2598 MD Primary

Addresses

NPPES NPI Registry

Primary practice location

140 Thomas Johnson Dr
Ste 100
Frederick, MD 21702-4475

Mailing address

5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
1007727620017MedicaidPA
408119600MedicaidMD
3810015779MedicaidWV

Other names 1

NPPES NPI Registry
  • Frederick Dialysis Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 5, 2024.

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1023078466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "140 THOMAS JOHNSON DR",
            "address_2": "STE 100",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024475",
            "telephone_number": "301-695-0900",
            "fax_number": "301-695-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "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": "E2598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007727620017",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408119600",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810015779",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Frederick Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Frederick Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.