Northwest Detroit Dialysis Center, LLC

Primary specialty

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

Legal business name

NORTHWEST DETROIT DIALYSIS CENTER, LLC

Practice address

7800 W Outer Dr
Suite 190
Detroit, MI 48235-3461

Phone

(313) 270-9239

Fax

(313) 270-9238

NPI assigned

Jul 20, 2006

Last updated

Mar 4, 2015By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 14

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

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

• Northwest Detroit Dialysis Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Southfield, MI
  • NPI 1083634463

  8527978675

  Same PAC ID
• Northwest Detroit Dialysis Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Southfield, MI
  • NPI 1295047710

  8527978675

  Same PAC ID

Listed as

Greenfield HS - Northwest DetroitCCN 232544

Overall star rating

1.0 of 5

Ownership

Non-profit

Certified

Jul 20, 1995

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Greenfield Health Systems

Dialysis stations

42

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

CLIA laboratory certificates

Tax ID family

Northwest Detroit Dialysis Center LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Northwest Detroit Dialysis Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Southfield, MI
  • NPI 1083634463
  NPD tax ID
• Northwest Detroit Dialysis Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Southfield, MI
  • NPI 1295047710
  NPD tax ID

Member of 1

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

• Henry Ford Health System

  • Clinical Pathology/Laboratory Medicine Physician
  • Detroit, MI
  • NPI 1336223635

  Member Of

  NPD member

Affiliated clinicians 5

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

• Mohamed A. Elshayeb, M.D

  • Nephrology Physician
  • Detroit, MI
  • NPI 1487918520

  Dialysis facility

  Care Compare affiliation Name & address match
• Jyothsna I Herek, M.D.

  • Nephrology Physician
  • West Bloomfield, MI
  • NPI 1669676169

  Dialysis facility

  Care Compare affiliation Name & address match
• Irfan Omar, M.D

  • Nephrology Physician
  • Southfield, MI
  • NPI 1841270196

  Dialysis facility

  Care Compare affiliation Name & address match
• Chadi Youssef Saad, MD

  • Nephrology Physician
  • Detroit, MI
  • NPI 1114193646

  Dialysis facility

  Care Compare affiliation Name & address match
• Yuvraj Sharma, M.D.

  • Nephrology Physician
  • Novi, MI
  • NPI 1952539777

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1083634471",
    "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": "480254514",
            "telephone_number": "248-642-5038",
            "fax_number": "248-642-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7800 W OUTER DR",
            "address_2": "SUITE 190",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353461",
            "telephone_number": "313-270-9239",
            "fax_number": "313-270-9238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST DETROIT DIALYSIS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2015-03-04",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED BLUE CROSS SECONDARY",
            "identifier": "09457",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICE",
            "identifier": "138129",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3194098",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREATLAKES",
            "identifier": "5066",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE",
            "identifier": "000000003402",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PRIMARY",
            "identifier": "08954",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "138129",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "232544",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "P09457",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMNICARE",
            "identifier": "1008733",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS SECONDARY",
            "identifier": "09457",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLNESS",
            "identifier": "10078540001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED BLUE CROSS PRIMARY",
            "identifier": "08954",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M CARE",
            "identifier": "14296",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Northwest Drug Rehabilitation Inc
• Northwest Eye Foundation
• Northwest Eye Foundation
• Northwest Housecall Doctor & Nurse Practitioners
• Northwest Industrail Drug Rehabilitation Clinic

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Detroit, MI
• Providers in Detroit, MI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.