Dialysis Centers of Northwest Arkansas, LLC

Primary specialty

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

Legal business name

DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLC

Doing business as

Hidden Springs Dialysis Center

Practice address

3000 NW a St
Bentonville, AR 72712-3985

Phone

(479) 463-7000

Fax

(479) 587-8421

NPI assigned

Nov 22, 2016

Last updated

Nov 22, 2016By 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

Robert S Bomstad, RN

Title

Ceo

Phone

(479) 463-7000

Specialties & licenses 1

Addresses

Other names 1

• Hidden Springs Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Other NPIs with the same Medicare PAC ID 4

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

• Dialysis Centers of Northwest Arkansas LLC

  dba North Hills Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fayetteville, AR
  • NPI 1942286315

  6800840802

  Same PAC ID
• Dialysis Centers of Northwest Arkansas, LLC

  dba Benton County Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bentonville, AR
  • NPI 1336220250

  6800840802

  Same PAC ID
• Dialysis Centers of Northwest Arkansas, LLC

  dba Dialysis Center of Siloam Springs

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Siloam Springs, AR
  • NPI 1437236908

  6800840802

  Same PAC ID
• Dialysis Centers of Northwest Arkansas, LLC

  dba Springdale Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Springdale, AR
  • NPI 1477027795

  6800840802

  Same PAC ID

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

Dialysis Centers of Northwest Arkansas LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Dialysis Centers of Northwest Arkansas, LLC

  dba Springdale Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Springdale, AR
  • NPI 1477027795
  NPD tax ID

Member of 2

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

• Mercy Hospital Rogers

  • Ambulance
  • Rogers, AR
  • NPI 1144695354

  Member Of

  NPD member
• Washington Regional Medical Center

  dba Washington Regional Home Health

  • Home Health Agency
  • Fayetteville, AR
  • NPI 1497956213

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479772800000",
    "number": "1104369297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E MONTE PAINTER DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034002",
            "telephone_number": "479-463-7000",
            "fax_number": "479-587-8421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NW A ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123985",
            "telephone_number": "479-463-7000",
            "fax_number": "479-587-8421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-22",
        "last_updated": "2016-11-22",
        "status": "A",
        "authorized_official_last_name": "BOMSTAD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-463-7000",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hidden Springs Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pardha Devaki, MD
• Deborah Devaraj
• Vinita Devarasetty
• Devon Davasher, LCSW PLLC
• Wenelle R. Dewitt, LPTA
• Dialysis Centers of Northwest Arkansas, LLC (Benton County Dialysis Center)
• Rodger C Dickinson Jr., M.D.
• Kristian Clymer Dietz, DDS
• Jaime Dietzen, LCSW
• Joseph Michael Dik, D.C.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Bentonville, AR
• Providers in Bentonville, AR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; 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.