Kinswa Dialysis LLC

Primary specialty

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

License

1042DC Issued in OH

Legal business name

KINSWA DIALYSIS LLC

Practice address

100 Pinnacle Dr
Fremont, OH 43420-7400

Phone

(419) 332-0310

Fax

(419) 332-0296

NPI assigned

Jun 12, 2012

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

• Fremont Regional Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Listed as

DaVita Fremont Regional DialysisCCN 362791

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Jan 3, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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 2

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

• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bourbonnais, IL
  • NPI 1073675138

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Locations

Practitioners 1

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

• Deanna Adol Shaffer

  • Administrator Registered Nurse
  • Fremont, OH
  • NPI 1407512437
  NPD (past)

Affiliated clinicians 1

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

• Shaukat Rashid, MD

  • Nephrology Physician
  • Perrysburg, OH
  • NPI 1437201795

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1124380456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "100 PINNACLE DR",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434207400",
            "telephone_number": "419-332-0310",
            "fax_number": "419-332-0296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINSWA DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-23",
        "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": "OH",
            "license": "1042DC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0085476",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fremont Regional Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fremont Regional Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelley Kelbley
• Dr Daniel Kelderhouse Inc, D.O.
• Kelly Randall MD Inc
• Kiran Khurshid, M.D.
• Patrick Kijowski, LISW
• Alexis Cecella Marie Klassen, DDS
• Joyce A Klein, MFN, RDN, CLT
• Robin Ann Knehr
• Holly A Knisely, PT
• Randal Koch, RPH

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fremont, OH
• Providers in Fremont, OH by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.