NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

Doing business as North Orangeburg Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Orangeburg, SC
National Provider Identifier
1093777146
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ERD-0023 Issued in SC
Legal business name
DVA HEALTHCARE RENAL CARE INC
Doing business as
North Orangeburg Dialysis
Practice address
124 Fire Tower Rd
Orangeburg, SC 29118-1401
Phone
(803) 531-6202
Fax
(803) 534-5263
NPI assigned
Apr 4, 2006
Last updated
Jan 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Authorized official

Name
Samuel T Wey
Title
VP Licensure & Certification
Phone
(012) 061-5203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X ERD-0023 SC Primary

Addresses

Primary practice location

124 Fire Tower Rd
Orangeburg, SC 29118-1401

Mailing address

5200 Virginia Way
Att: L&C Department
Brentwood, TN 37027-7569
Phone (615) 320-4593

Other identifiers 2

IdentifierTypeStateIssuer
01808319MedicaidNY
422508MedicaidSC

Other names 1

  • North Orangeburg Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030520000000 SC Part A Provider - End-Stage Renal Disease Facility (ESRD) 7517875545 Practice locations: Orangeburg, SC

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita North Orangeburg DialysisCCN 422508
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Dec 3, 1979
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
24

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
42D0687972North Orangeburg Dialysis124 Fire Tower Rd, Orangeburg, SC 29118Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Community Dialysis Services194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 8

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Member of 1

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

Locations

124 Fire Tower Rd
Orangeburg, SC 29118
Phone (803) 531-6202

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1093777146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4593",
            "fax_number": "800-293-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 FIRE TOWER RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291181401",
            "telephone_number": "803-531-6202",
            "fax_number": "803-534-5263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-24",
        "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": "012-061-5203"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "SC",
            "license": "ERD-0023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01808319",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "422508",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Orangeburg Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Orangeburg Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orangeburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.