Active NPI
Northwest Detroit Dialysis Center LLC
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Southfield, MI
National Provider Identifier
1083634463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- NORTHWEST DETROIT DIALYSIS CENTER LLC
- Practice address
- 25664 Lahser Rd
Southfield, MI 48033-5810 - Phone
- (248) 358-7521
- Fax
- (248) 358-7522
- NPI assigned
- Jul 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. David F Shepherd
- Title
- Vice President
- Phone
- (248) 642-5038
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Primary |
Addresses
Primary practice location
25664 Lahser Rd
Southfield, MI 48033-5810
Mailing address
30100 Telegraph Rd
Suite 200
Bingham Farms, MI 48025-4516
Phone (248) 723-0224
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14296 | Other | M CARE | |
| 10078540001 | Other | WELLNESS | |
| 1008733 | Other | OMNICARE | |
| D8956 | Other | FED BLUE CROSS PRIMARY | |
| 232544 | Other | HAP | |
| 4568218 | Medicaid | MI | |
| 000000003402 | Other | CAPE | |
| 138129 | Other | PREFERRED CHOICE | |
| 138129 | Other | CARE CHOICES | |
| D8956 | Other | BLUE CROSS PRIMARY | |
| D9466 | Other | BLUE CROSS SECONDARY | |
| D9466 | Other | FED BLUE CROSS SECONDARY | |
| P09457 | Other | BLUE CARE NETWORK | |
| 5066 | Other | GREATLAKES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030616000016 | MI | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 8527978675 | Practice locations: Southfield, MI |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Southfield, MI
- NPI 1295047710
8527978675
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Detroit, MI
- NPI 1083634471
8527978675
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- NW Detroit Dialysis - Lahser Satellite
- Overall star rating
- Ownership
- Profit
- Certified
- Sep 26, 2003
- Medicare certification status
- Active
- Chain
- Greenfield Health Systems
- Dialysis stations
- 24
Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.
National Provider Directory
National Provider Directory- Tax ID family
- Northwest Detroit Dialysis Center LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Southfield, MI
- NPI 1295047710
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Detroit, MI
- NPI 1083634471
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
21000 Northwestern Hwy
Southfield, MI 48075
Phone (248) 557-7000
Practitioners & affiliated clinicians
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1350259200000",
"number": "1083634463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30100 TELEGRAPH RD",
"address_2": "SUITE 200",
"city": "BINGHAM FARMS",
"state": "MI",
"postal_code": "480254516",
"telephone_number": "248-723-0224",
"fax_number": "248-642-7852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25664 LAHSER RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480335810",
"telephone_number": "248-358-7521",
"fax_number": "248-358-7522"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTHWEST DETROIT DIALYSIS CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-20",
"last_updated": "2012-10-15",
"status": "A",
"authorized_official_last_name": "SHEPHERD",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "248-642-5038",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "M CARE",
"identifier": "14296",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLNESS",
"identifier": "10078540001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OMNICARE",
"identifier": "1008733",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FED BLUE CROSS PRIMARY",
"identifier": "D8956",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAP",
"identifier": "232544",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4568218",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPE",
"identifier": "000000003402",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CHOICE",
"identifier": "138129",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICES",
"identifier": "138129",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PRIMARY",
"identifier": "D8956",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS SECONDARY",
"identifier": "D9466",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FED BLUE CROSS SECONDARY",
"identifier": "D9466",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "P09457",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREATLAKES",
"identifier": "5066",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
- Northland Retina Assoc (Oakland Retina Cons)
- Northwest Cardiology, P.C.
- Northwest Counseling & Psycotherapy Center
- Northwest Critical Care Surgeons, PLLC
- Northwest Dermatolgy Group, PC
- Northwest Detroit Dialysis Center LLC
- Northwest Eye Physicians, P.C.
- Northwest Home Health Services Inc (Metro Home Care)
- Northwest Neurology PC (Northwest Neurology and Neurodiagnostic Center)
- Northwest Ophthalmology,PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.