Prattville Community Dialysis LLC

Primary specialty

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

Legal business name

PRATTVILLE COMMUNITY DIALYSIS LLC

Practice address

1815 Glynwood Dr
Prattville, AL 36066-5584

Phone

(610) 495-8900

Fax

(610) 495-8562

NPI assigned

Jan 10, 2018

Organization subpart

No

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

Authorized official

Name

Kelly Smith

Title

Director

Phone

(302) 290-7408

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Listed as

Prattville Community DialysisCCN 012704

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Feb 21, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Other

Dialysis stations

9

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

CLIA laboratory certificates

Affiliated clinicians 2

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

• Rafael A Lopez, M.D.

  • Specialist
  • Montgomery, AL
  • NPI 1700890936

  Dialysis facility

  Care Compare affiliation Name & address match
• Jogy Varghese, M.D.

  • Nephrology Physician
  • Montgomery, AL
  • NPI 1841380284

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735776000000",
    "number": "1114434230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 COMMERCE CT STE 104",
            "city": "POTTSTOWN",
            "state": "PA",
            "postal_code": "194643483",
            "telephone_number": "302-290-7408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 GLYNWOOD DR",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360665584",
            "telephone_number": "610-495-8900",
            "fax_number": "610-495-8562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRATTVILLE COMMUNITY DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-10",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "302-290-7408"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Dean Pinson
• Megan Elizabeth Pitts, M.S., CCC-SLP
• Cayla Jaye Polk, MCD, CCC-SLP
• Christian Poyner
• Prattville Christian Family Medicine
• Prattville Dental Associates, LLC
• Prattville Health and Rehabilitation LLC
• Prattville Heart Center LLC
• Prattville Home Midwifery, LLC
• Prattville Medical Clinic, PC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Prattville, AL
• Providers in Prattville, AL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; 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.