Active NPI
Dialysis Clinic Inc.
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Shelby, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- DIALYSIS CLINIC INC.
- Practice address
- 108 Creekside Drive
Shelby, NC 28152 - Phone
- (704) 434-2291
- Fax
- (704) 434-6619
- NPI assigned
- May 15, 2007
- Last updated
- Oct 4, 2023
- 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
- Mr. Donovan Schultz
- Title
- President
- Phone
- (615) 327-3061
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | NU | Primary |
Addresses
Primary practice location
108 Creekside Drive
Shelby, NC 28152
Mailing address
1016 N Lafayette St
Shelby, NC 28150-3835
Phone (704) 481-8405
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NDC003 | Medicaid | SC | |
| 3402661 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070717000627 | NC | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Shelby, NC |
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- Dci - Dialysis Clinic, Inc
- Overall star rating
- Ownership
- Profit
- Certified
- May 21, 2008
- Medicare certification status
- Active
- Chain
- Dialysis Clinic, Inc.
- Dialysis stations
- 15
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 |
|---|---|---|---|
| 34D1082060 | Dialysis Clinic Inc-Boiling Springs | Certificate of waiver | Mar 31, 2028 |
National Provider Directory
National Provider Directory- Tax ID family
- Dialysis Clinic Inc
Organizations with this tax ID in the same state 3
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Shelby, NC
- NPI 1295768679
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Shelby, NC
- NPI 1538312434
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Kings Mountain, NC
- NPI 1689693822
Locations
108 Creekside Dr
Shelby, NC 28152
Phone (704) 434-2291
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Rancho Dialysis Clinic | Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Dec 24, 2003 Dec 24, 2003 |
Practitioners & affiliated clinicians
Affiliated clinicians 1
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": "1179187200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1696377600000",
"number": "1184830457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1016 N LAFAYETTE ST",
"city": "SHELBY",
"state": "NC",
"postal_code": "281503835",
"telephone_number": "704-481-8405",
"fax_number": "804-481-8162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 CREEKSIDE DRIVE",
"city": "SHELBY",
"state": "NC",
"postal_code": "28152",
"telephone_number": "704-434-2291",
"fax_number": "704-434-6619"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DIALYSIS CLINIC INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-15",
"last_updated": "2023-10-04",
"certification_date": "2023-10-04",
"status": "A",
"authorized_official_last_name": "SCHULTZ",
"authorized_official_first_name": "DONOVAN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "615-327-3061",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NDC003",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3402661",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Shelby, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.