Kimball Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

KIMBALL DIALYSIS LLC

Practice address

920 S Washington Ave
Scranton, PA 18505-3810

Phone

(570) 344-5267

Fax

(570) 963-2125

NPI assigned

Mar 24, 2012

Organization subpart

No

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

Authorized official

Name

Samuel T Wey

Title

Sr Dir Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Commonwealth Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Kimball Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Moosic, PA
  • NPI 1770927436

  2264695345

  Same PAC ID

Listed as

DaVita Commonwealth DialysisCCN 392761

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Sep 11, 2012

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

13

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Commonwealth Dialysis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Kimball Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Moosic, PA
  • NPI 1770927436
  NPD tax ID

Member of 2

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

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockfrd, IL
  • NPI 1154997591

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Castle Rock, CO
  • NPI 1386928430

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Henry C Yeager III, MD

  • Case Manager/Care Coordinator
  • Scranton, PA
  • NPI 1376685164
  NPD (past)

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Ferdinand J Manahan, MD

  • Internal Medicine Physician
  • Scranton, PA
  • NPI 1104805126

  Dialysis facility

  Care Compare affiliation Name & address match
• Lindsay M Smith, D.O.

  • Nephrology Physician
  • Dunmore, PA
  • NPI 1891093241

  Dialysis facility

  Care Compare affiliation Name & address match
• Henry C Yeager III, MD

  • Case Manager/Care Coordinator
  • Scranton, PA
  • NPI 1376685164

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1332547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1174899173",
    "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": "920 S WASHINGTON AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185053810",
            "telephone_number": "570-344-5267",
            "fax_number": "570-963-2125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBALL DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-24",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR DIR 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": "1027729300001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Commonwealth Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Commonwealth Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Ann Kilvitis, RPH
• Eul K Kim, MD
• Joseph Hyungeun Kim, DPM
• Michael D Kim, D.O.
• SE Rin Kim
• Katrina Kincel, PA-C
• Kayla Kincel, HIS
• Kindred Total Care LLC
• Kenneth Joseph Kindya, PH.D.
• Cheryl L King, SPL

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Scranton, PA
• Providers in Scranton, PA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.