NPIMap

Organization Active NPI

Dva Healthcare of Maryland LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Baltimore, MD
National Provider Identifier
1154381663
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E2523 Issued in MD
Legal business name
DVA HEALTHCARE OF MARYLAND LLC
Practice address
1 Nashua CT
Ste E
Baltimore, MD 21221-3131
Phone
(410) 687-5580
Fax
(410) 687-8559
NPI assigned
Mar 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X E2523 MD Primary

Addresses

Primary practice location

1 Nashua CT
Ste E
Baltimore, MD 21221-3131

Mailing address

5200 Virginia Way
L & C Department
Brentwood, TN 37027-7569
Phone (615) 320-4214

Other identifiers 2

IdentifierTypeStateIssuer
1007727620012MedicaidPA
523504900MedicaidMD

Other names 1

  • Whitesquare Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030430000040 MD Part A Provider - End-Stage Renal Disease Facility (ESRD) 8426968256 Practice locations: Baltimore, MD

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Whitesquare DialysisCCN 212523
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Dec 1, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
18

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
21D0944150Whitesquare Dialysis1 Nashua Court Ste E, Baltimore, MD 21221Certificate of waiverApr 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Dva Healthcare of Maryland LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Locations

6830 Hospital Dr
Rosedale, MD 21237

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": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670198400000",
    "number": "1154381663",
    "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": "615-320-4214",
            "fax_number": "866-944-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 NASHUA CT",
            "address_2": "STE E",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212213131",
            "telephone_number": "410-687-5580",
            "fax_number": "410-687-8559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "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": "E2523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007727620012",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "523504900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whitesquare Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Whitesquare Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; 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.