NPIMap

Organization Active NPI

Dva Renal Healthcare Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Wilson, NC
National Provider Identifier
1154380889
Registry record updated Aug 8, 2023
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
Practice address
1605 Medical Park Dr W
Wilson, NC 27893-2799
Phone
(252) 265-0020
Fax
(252) 265-0645
NPI assigned
Mar 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Authorized official

Name
Samuel T Wey
Title
Sr Director 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

1605 Medical Park Dr W
Wilson, NC 27893-2799

Mailing address

5200 Virginia Way
L & C Department
Brentwood, TN 37027-7569
Phone (615) 320-4593

Other identifiers 1

IdentifierTypeStateIssuer
3402637MedicaidNC

Other names 1

  • Forest Hills Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301000755 NC Part A Provider - End-Stage Renal Disease Facility (ESRD) 0840107611 Practice locations: Wilson, NC

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Forest Hills DialysisCCN 342637
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Mar 10, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
31

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
34D1020752Forest Hills Dialysis1605 Medical Park Drive W, Wilson, NC 27893Certificate of waiverDec 30, 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.

Member of 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691452800000",
    "number": "1154380889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L & C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4593",
            "fax_number": "800-293-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 MEDICAL PARK DR W",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278932799",
            "telephone_number": "252-265-0020",
            "fax_number": "252-265-0645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR DIRECTOR 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": "3402637",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forest Hills Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Forest Hills Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.

Verify at the official NPI Registry.