Decklund Dialysis LLC

Primary specialty

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

Legal business name

DECKLUND DIALYSIS LLC

Practice address

265 Wilmington W Chester Pike
Chadds Ford, PA 19317-9039

Phone

(610) 558-6965

Fax

(610) 558-7806

NPI assigned

Jun 7, 2017

Organization subpart

No

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

Authorized official

Name

Samuel Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Concord Township Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Listed as

DaVita Concord Township DialysisCCN 392862

Overall star rating

5.0 of 5

Ownership

Profit

Certified

Sep 20, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

13

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 2

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
  • Rockfrd, IL
  • NPI 1154997591

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Napa, CA
  • NPI 1295024206

  Member Of

  NPD member

Locations

Affiliated clinicians 3

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

• Heather Marie Mascio, D.O

  • Nephrology Physician
  • Chester, PA
  • NPI 1962633610

  Dialysis facility

  Care Compare affiliation Name & address match
• Chike Nathan Okechukwu, M.D.

  • Nephrology Physician
  • Upland, PA
  • NPI 1174578215

  Dialysis facility

  Care Compare affiliation Name & address match
• Laura Panarey Raymond, D.O.

  • Nephrology Physician
  • Philadelphia, PA
  • NPI 1699062174

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1063941607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "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": "265 WILMINGTON W CHESTER PIKE",
            "city": "CHADDS FORD",
            "state": "PA",
            "postal_code": "193179039",
            "telephone_number": "610-558-6965",
            "fax_number": "610-558-7806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECKLUND DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-07",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": "103493170",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Concord Township Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Counseling for Resilience and Growth LLC
• CR Nutrition and Wellness, LLC
• Renee Crossman
• Janice Louise Curran, PHARMACIST
• Dalesio and Associates, Inc.
• Dental Implant & Periodontal Surgeons of Maine Line, P.C.
• Joseph Felix Desantis, D.M.D.
• Disabatino Chiropractic Centre Inc
• Dominick G Disabatino, D.C.
• Doc on the Block

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Chadds Ford, PA
• Providers in Chadds Ford, PA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.