Renal Treatment Centers-Southeast, LP.

Primary specialty

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

Legal business name

RENAL TREATMENT CENTERS-SOUTHEAST, LP.

Doing business as

Bradley County Dialysis

Practice address

204 Bragg St
Warren, AR 71671-2500

Phone

(870) 226-7180

Fax

(870) 226-2488

NPI assigned

Nov 21, 2012

Last updated

Jan 17, 2024By the provider in NPPES

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

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bradley County Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Renal Treatment Centers-Southeast, LP.

  dba River Valley Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Russellville, AR
  • NPI 1285978627

  O20151222001866

  Same enrollment

Listed as

DaVita Bradley County DialysisCCN 042576

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Oct 14, 2005

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

16

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

CLIA laboratory certificates

Locations

Affiliated clinicians 2

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

• David Desoto, M.D.

  • Nephrology Physician
  • Hot Springs, AR
  • NPI 1598745846

  Dialysis facility

  Care Compare affiliation Name & address match
• Michael D Schonefeld, M.D.

  • Nephrology Physician
  • El Dorado, AR
  • NPI 1245210590

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1353456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1194069617",
    "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": "615-320-4268",
            "fax_number": "877-238-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 BRAGG ST",
            "city": "WARREN",
            "state": "AR",
            "postal_code": "716712500",
            "telephone_number": "870-226-7180",
            "fax_number": "870-226-2488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-SOUTHEAST, LP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-21",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200362134",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bradley County Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bradley County Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kerry Franklin Pennington, M.D.
• Precious Jewels Birthing Project Inc
• Kenneth W Purvis, MD
• Wendy Michelle Ray, PMHNP
• Heath A Reep, ANP
• Jo Ella Reynolds, P.T.A.
• Karen J. Richardson, APN
• Mary Richesin, PTA
• Robert W Smalling OD PA
• Galen S Robinson, MHPP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Warren, AR
• Providers in Warren, AR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.