Active NPI
Kidney Home Center LLC
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Glen Burnie, MD
National Provider Identifier
1144597196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- E2674
- Legal business name
- KIDNEY HOME CENTER LLC
- Practice address
- 6934 Aviation Blvd
Ste H
Glen Burnie, MD 21061-2593 - Phone
- (410) 760-4976
- Fax
- (410) 761-1040
- NPI assigned
- Nov 18, 2011
- 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 | E2674 | MD | Primary |
Addresses
Primary practice location
6934 Aviation Blvd
Ste H
Glen Burnie, MD 21061-2593
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4214
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 421454400 | Medicaid | MD |
Other names 1
- Glen Burnie Home Training
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120420000165 | MD | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 4981762903 | Practice locations: Glen Burnie, MD |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Windsor Mill, MD
- NPI 1457500894
4981762903
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Baltimore, MD
- NPI 1346621554
4981762903
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita Glen Burnie Home Training
- Overall star rating
- Ownership
- Profit
- Certified
- Apr 30, 2013
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 6
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 |
|---|---|---|---|
| 21D2042108 | Glen Burnie Home Training | Certificate of waiver | Jun 5, 2028 |
National Provider Directory
National Provider Directory- Tax ID family
- Glen Burnie Home Training
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Windsor Mill, MD
- NPI 1457500894
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Baltimore, MD
- NPI 1346621554
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Castle Rock, CO
- NPI 1386928430
Member Of
Practitioners & affiliated clinicians
Affiliated clinicians 6
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": "1321574400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1682294400000",
"number": "1144597196",
"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": "615-320-4214",
"fax_number": "866-944-3352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6934 AVIATION BLVD",
"address_2": "STE H",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210612593",
"telephone_number": "410-760-4976",
"fax_number": "410-761-1040"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KIDNEY HOME CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2011-11-18",
"last_updated": "2023-04-24",
"certification_date": "2023-04-24",
"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": "MD",
"license": "E2674",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "421454400",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Glen Burnie Home Training",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Glen Burnie Home Training",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Glen Burnie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; 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.