NPIMap

Organization Active NPI

Dialysis Clinic, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Oswego, NY
National Provider Identifier
1104842194
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
3301213R Issued in NY
Legal business name
DIALYSIS CLINIC, INC.
Practice address
180W 3Rd St
Oswego, NY 13126
Phone
(315) 342-3045
Fax
(315) 342-3491
NPI assigned
Jul 14, 2006
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Mr. Donovan Schultz
Title
President
Phone
(615) 327-3061

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 3301213R NY Primary

Addresses

Primary practice location

180W 3Rd St
Oswego, NY 13126

Mailing address

1127 E Genesee St
Syracuse, NY 13210-1911
Phone (315) 473-5100

Other identifiers 2

IdentifierTypeStateIssuer
01367239MedicaidNY
03007861MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100222000266 NY Part A Provider - End-Stage Renal Disease Facility (ESRD) 4284541129 Practice locations: Oswego, NY

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Dci - Univ. Dialysis Ctr @ OswegoCCN 332580
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Mar 19, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Dialysis Clinic, Inc.
Dialysis stations
19

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
Dialysis Clinic Inc238 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

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

View all 14

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rancho Dialysis ClinicSacramento, CA, CCN 552519 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 24, 2003
Dec 24, 2003

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1104842194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 E GENESEE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101911",
            "telephone_number": "315-473-5100",
            "fax_number": "315-473-6037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180W 3RD ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "13126",
            "telephone_number": "315-342-3045",
            "fax_number": "315-342-3491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DONOVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-327-3061",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "3301213R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01367239",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03007861",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oswego, NY

Sources for this page

Verify at the official NPI Registry.