Active NPI
Isd Renal Inc
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
National Provider Identifier
1134640949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- ISD RENAL INC
- Practice address
- 1236 N 26TH St
Philadelphia, PA 19121-4602 - Phone
- (215) 763-3974
- Fax
- (215) 765-1494
- NPI assigned
- Jun 30, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John D Winstel
- Title
- Chief Accounting Officer
- Phone
- (253) 733-4501
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Primary |
Addresses
Primary practice location
1236 N 26TH St
Philadelphia, PA 19121-4602
Mailing address
5200 Virginia Way
L & C Dept
Brentwood, TN 37027-7569
Phone (615) 341-6410
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102029010 | Medicaid | PA |
Other names 1
- Fairmount Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180410000782 | PA | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 6507053790 | Practice locations: Philadelphia, PA |
Other NPIs with the same Medicare PAC ID 24
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1235795204
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1295344307
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Upper Darby, PA
- NPI 1316540388
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1336758549
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1417566621
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Lansdale, PA
- NPI 1730697939
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1306322516
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Cookeville, TN
- NPI 1003390469
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Greensboro, GA
- NPI 1073816914
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Indianapolis, IN
- NPI 1174006662
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- North Providence, RI
- NPI 1174579619
6507053790
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Pennsauken, NJ
- NPI 1194230441
6507053790
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita Fairmount Dialysis
- Overall star rating
- Ownership
- Profit
- Certified
- May 4, 2018
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 17
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 NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D2138173 | Fairmount Dialysis | Certificate of waiver | Oct 11, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Renal Care of Marion
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.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1235795204
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1295344307
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Upper Darby, PA
- NPI 1316540388
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1336195742
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1336758549
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1376580464
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1417566621
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Lansdale, PA
- NPI 1730697939
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Philadelphia, PA
- NPI 1306322516
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Pearsall, TX
- NPI 1194789859
Member Of
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": "1498780800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1596758400000",
"number": "1134640949",
"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",
"telephone_number": "615-341-6410",
"fax_number": "888-662-8259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1236 N 26TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191214602",
"telephone_number": "215-763-3974",
"fax_number": "215-765-1494"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ISD RENAL INC",
"organizational_subpart": "NO",
"enumeration_date": "2017-06-30",
"last_updated": "2020-08-07",
"certification_date": "2020-08-07",
"status": "A",
"authorized_official_last_name": "WINSTEL",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
"authorized_official_telephone_number": "253-733-4501"
},
"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": "102029010",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Fairmount Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Fairmount Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; 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.