Direct Dialysis

Primary specialty

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

Legal business name

DIRECT DIALYSIS

Practice address

14255 Cicero Ave
Crestwood, IL 60445-2154

Phone

(708) 824-9200

NPI assigned

Aug 21, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michael Charles Braun

Title

Controller

Phone

(847) 583-0100

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093821522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14255 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604452154",
            "telephone_number": "708-824-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14255 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604452154",
            "telephone_number": "708-824-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIRECT DIALYSIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRAUN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "847-583-0100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sakeena Dean
• Daniel C Desimone, MD
• Dialysis Centers of America - Illinois, Inc.
• Steven James Diclemente, MPT, CSCS
• Sarah Dillon, MSW, TYPE-73
• Jennifer Kathleen Donovan, PHARMD
• Manjhoni Edmondson
• Sima Eghtesad
• Amin Elsaeed, DMD
• Malak Elsheikh, M.B.B.S

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Crestwood, IL
• Providers in Crestwood, IL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.