NPIMap

Organization Active NPI

Kingston Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Lakewood, CO
National Provider Identifier
1164890604
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
12R950 Issued in CO
Legal business name
KINGSTON DIALYSIS LLC
Practice address
1750 Pierce St Ste a
Lakewood, CO 80214
Phone
(303) 232-0939
Fax
(303) 274-6096
NPI assigned
Sep 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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 12R950 CO Primary

Addresses

Primary practice location

1750 Pierce St Ste a
Lakewood, CO 80214

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
36032395MedicaidCO

Other names 1

  • Mile High Home Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170124000175 CO Part A Provider - End-Stage Renal Disease Facility (ESRD) 2365751005 Practice locations: Lakewood, CO

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Kingston Dialysis LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

9950 W 80th Ave
Ste 25
Arvada, CO 80005
Phone (303) 456-9556

1750 Pierce St
Ste C
Lakewood, CO 80214
Phone (303) 238-6111

1057 S Wadsworth Blvd
Ste 100
Lakewood, CO 80226
Phone (720) 962-6199

NPI Registry JSON

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1164890604",
    "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": "1750 PIERCE ST STE A",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "80214",
            "telephone_number": "303-232-0939",
            "fax_number": "303-274-6096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSTON DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-14",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "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": "CO",
            "license": "12R950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36032395",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mile High Home Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mile High Home Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.