Nra-Holly Hill, South Carolina, LLC

Primary specialty

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

License

ERD-137 Issued in SC

Legal business name

NRA-HOLLY HILL, SOUTH CAROLINA, LLC

Practice address

8532 Old State Rd
Holly Hill, SC 29059-8379

Phone

(803) 496-2800

Fax

(803) 496-2808

NPI assigned

Jun 13, 2006

Organization subpart

Yes

Parent organization

FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

Name

Barry L. Blanton

Title

Vice President

Phone

(781) 699-9000

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

• National Medical Care, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bristol, TN
  • NPI 1477570117
  NPD member Member Of

Medicare fee-for-service enrollment

Enrolled in SC

• HOLLY HILL DIALYSIS CLINIC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 17, 2023.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1124061809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8532 OLD STATE RD",
            "city": "HOLLY HILL",
            "state": "SC",
            "postal_code": "290598379",
            "telephone_number": "803-496-2800",
            "fax_number": "803-496-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8532 OLD STATE RD",
            "city": "HOLLY HILL",
            "state": "SC",
            "postal_code": "290598379",
            "telephone_number": "803-496-2800",
            "fax_number": "803-496-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NRA-HOLLY HILL, SOUTH CAROLINA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2006-06-13",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "BLANTON",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "781-699-9000"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "SC",
            "license": "ERD-137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ERD137",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATE OF WAIVE",
            "identifier": "42D1011035",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "HOLLY HILL DIALYSIS CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Holly Hill, SC
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.