Dva Healthcare Renal Care Inc

Primary specialty

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

Legal business name

DVA HEALTHCARE RENAL CARE INC

Doing business as

Oklahoma City South Dialysis

Practice address

319 SW 59TH St
Oklahoma City, OK 73109-8301

Phone

(405) 634-3708

Fax

(405) 636-1211

NPI assigned

Apr 3, 2006

Organization subpart

No

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

Authorized official

Name

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Oklahoma City South Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Listed as

DaVita Oklahoma City South DialysisCCN 372518

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Aug 13, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

16

Tax ID family

CDS of Zephyrhills194 organizations share this tax ID, including this one

Member of 1

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

• Dva Renal Healthcare Inc

  dba Pageland Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pageland, SC
  • NPI 1548222615

  Member Of

  NPD member

Affiliated clinicians 2

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

• Usman Bhutta, MD

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1588896997

  Dialysis facility

  Care Compare affiliation Name & address match
• Wudeneh Zewdie, M.D.

  • Nephrology Physician
  • Midwest City, OK
  • NPI 1538121421

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1124080486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 SW 59TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731098301",
            "telephone_number": "405-634-3708",
            "fax_number": "405-636-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100757220B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oklahoma City South Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oklahoma City South Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Dutcher, LMFT
• Sakuntala Dutta, M.D
• Georgeann Nigh Duty, MS, LPC
• Eric John Duval, D.O.
• Katie Lee Duzan-Osborn
• Dva Renal Healthcare Inc (Lexington OK Prison)
• Dva Renal Healthcare Inc (Heartland Dialysis)
• Alex Agyei Dwuma, MD
• Harlee Nicole Dwyer, MD
• Stacy Lea Dwyer, APRN-CNP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; 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.