Verde Dialysis LLC | NPI 1033355458

Key facts

NPI: 1033355458
Entity type: Organization (NPI type 2)
Primary specialty: End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
Legal business name: VERDE DIALYSIS LLC
Practice address: 150 Brooks Way
Ste 15
Brooks, KY 40109-6105
Phone: (502) 955-2153
Fax: (502) 955-2174
NPI assigned: Jan 7, 2009
Organization subpart: No

Authorized official

Name: Samuel T Wey
Title: VP Licensure&Certification
Phone: (615) 341-6641

Member of 1

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

Total Renal Care Inc End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Burlington, WA · NPI 1932595584

NPD member Member Of

Practitioners 1

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

Lindsay Avis, APRN Psychiatric/Mental Health Nurse Practitioner · Bowling Green, KY · NPI 1801692413

NPD (past)

Affiliated clinicians 1

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

Ashwin Dixit, M.D. Nephrology Physician · Louisville, KY · NPI 1699736215

Care Compare affiliation Name & address match Dialysis facility

Medicare Care Compare: Dialysis facility

Listed as: DaVita Shepherdsville Dialysis Center CCN 182600
Overall star rating: ★★★★☆ 4.0 of 5
Ownership: Profit
Certified: Aug 29, 2009
Medicare certification status: Active (Provider of Services file)
Chain: DaVita
Dialysis stations: 12

Source: Medicare Care Compare. Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
18D1098437	Shepherdsville Dialysis Center 150 Brooks Way Ste 15, Brooks, KY 40109	Certificate of waiver	Apr 19, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in KY

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20090212000433	KY	Part a Provider - End-Stage Renal Disease Facility (ESRD)	3678638376	Practice locations: Brooks, KY

National Provider Directory

Locations

150 Brooks Way
Ste 15
Brooks, KY 40109
Phone (502) 955-2153

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center	261QE0700X			Yes

Addresses

Primary practice location

150 Brooks Way
Ste 15
Brooks, KY 40109-6105

Mailing address

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

Other identifiers

Identifier	Type	State	Issuer
7100100390	Medicaid	KY

Other names

Shepherdsville Dialysis Center Doing business as

Other providers in Brooks, KY

All providers in Brooks, KY · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Kentucky

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.