Northside Dialysis Center of Wake Forest University

Primary specialty

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

Legal business name

NORTHSIDE DIALYSIS CENTER OF WAKE FOREST UNIVERSITY

Practice address

500 W Hanes Mill Rd
Winston Salem, NC 27105-9814

Phone

(336) 744-0577

Fax

(336) 744-9021

NPI assigned

Dec 30, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Kimberly Agee-Clark Johnson, MBA

Title

Credentialing Coord.

Phone

(229) 387-3528

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Northside Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Listed as

Northside Dialysis CenterCCN 342612

Overall star rating

1.0 of 5

Ownership

Non-profit

Certified

Oct 19, 2001

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Wake Forest University

Dialysis stations

45

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

CLIA laboratory certificates

Member of 1

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

• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1134731227

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin High, MD

  • Infectious Disease Physician
  • Winston Salem, NC
  • NPI 1144205428
  NPD (past)

Affiliated clinicians 8

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

• Anthony Bleyer, MD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1346225778

  Dialysis facility

  Care Compare affiliation Name & address match
• Isai G Bowline, MD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1225260391

  Dialysis facility

  Care Compare affiliation Name & address match
• Pirouz Daeihagh, MD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1083699417

  Dialysis facility

  Care Compare affiliation Name & address match
• Alexander Cox Hadley, MD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1881679215

  Dialysis facility

  Care Compare affiliation Name & address match
• Nicholas Oliver McLean, MD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1205193331

  Dialysis facility

  Care Compare affiliation Name & address match
• Mariana Murea, MD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1396792321

  Dialysis facility

  Care Compare affiliation Name & address match
• Todd Wayne Robinson, M.D.

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1447485495

  Dialysis facility

  Care Compare affiliation Name & address match
• Scott Gregory Satko, MD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1962487397

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770595200000",
    "number": "1114904133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7350",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317937350",
            "telephone_number": "229-387-3528",
            "fax_number": "229-386-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W HANES MILL RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271059814",
            "telephone_number": "336-744-0577",
            "fax_number": "336-744-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE DIALYSIS CENTER OF WAKE FOREST UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-30",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "AGEE-CLARK",
        "authorized_official_title_or_position": "CREDENTIALING COORD.",
        "authorized_official_telephone_number": "229-387-3528",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3402612",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northside Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• North Point Dental Care
• James Matthew North, MD
• Rod North, LCSW
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• Lauren Alexandra Northrup, CCC, SLP
• Northstar Residential and Community Services, LLC
• Northwest Community Care Network
• Dustin Lee Norton, M.D.
• Michael James Norton, M.D.
• Tonya Dean Norton, NNP-BC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2026; 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.