NPIMap

Organization Active NPI

Dva Renal Healthcare Inc

Doing business as Washington Square Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Washington, MO
National Provider Identifier
1134180680
Registry record updated Aug 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DVA RENAL HEALTHCARE INC
Doing business as
Washington Square Dialysis
Practice address
1112 Washington SQ
Washington, MO 63090-5336
Phone
(636) 390-8233
Fax
(636) 390-2771
NPI assigned
Mar 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2026

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

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

1112 Washington SQ
Washington, MO 63090-5336

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
502928047MedicaidMO

Other names 1

  • Washington Square Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030416000008 MO Part A Provider - End-Stage Renal Disease Facility (ESRD) 0840107611 Practice locations: Washington, MO

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Washington Square DialysisCCN 262562
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Apr 13, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
16

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0936592Washington Square Dialysis1112 Washington Square, Washington, MO 63090Certificate of waiverNov 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gambro Healthcare Anahe173 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 9

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786665600000",
    "number": "1134180680",
    "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": "1112 WASHINGTON SQ",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630905336",
            "telephone_number": "636-390-8233",
            "fax_number": "636-390-2771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "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": "502928047",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washington Square Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Washington Square Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 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.