NPIMap

Organization Active NPI

Dialysis of Northern Illinois LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sycamore, IL
National Provider Identifier
1184900920
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DIALYSIS OF NORTHERN ILLINOIS LLC
Practice address
2540 Hauser Ross Dr Ste 200
Sycamore, IL 60178-3171
Phone
(815) 748-3508
Fax
(815) 748-3825
NPI assigned
Oct 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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 Primary

Addresses

Primary practice location

2540 Hauser Ross Dr Ste 200
Sycamore, IL 60178-3171

Mailing address

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

Other names 1

  • Crimson Ridge Home Training Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111104000620 IL Part A Provider - End-Stage Renal Disease Facility (ESRD) 7012972029 Practice locations: Sycamore, IL

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Crimson Ridge Home Training (PD)CCN 142748
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Jan 17, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Dialysis of Northern Illinois LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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.

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": "1319500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740700800000",
    "number": "1184900920",
    "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": "2540 HAUSER ROSS DR STE 200",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783171",
            "telephone_number": "815-748-3508",
            "fax_number": "815-748-3825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS OF NORTHERN ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-25",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crimson Ridge Home Training",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crimson Ridge Home Training",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sycamore, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2025; 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.