NPIMap

Organization Active NPI

Rockaway HD LLC

Doing business as Rockaway Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Far Rockaway, NY
National Provider Identifier
1194085662
Registry record updated Jul 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
206115 Issued in NY
Legal business name
ROCKAWAY HD LLC
Doing business as
Rockaway Dialysis
Practice address
529 Beach 20TH St
1St Floor
Far Rockaway, NY 11691-3645
Phone
(718) 327-7307
Fax
(718) 327-3297
NPI assigned
May 18, 2012
Last updated
Jul 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2012

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

Authorized official

Name
Dr. Olusegun Ogunfowora, M.DNPI 1275602963
Title
Ceo
Phone
(718) 327-4503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 206115 NY Primary

Addresses

Primary practice location

529 Beach 20TH St
1St Floor
Far Rockaway, NY 11691-3645

Mailing address

529 Beach 20TH Street
1St Floor
Far Rockaway, NY 11691-3645
Phone (718) 327-4503

Other names 1

  • Rockaway Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120920000249 NY Part A Provider - End-Stage Renal Disease Facility (ESRD) 3678721461 Practice locations: Far Rockaway, NY

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Rockaway DialysisCCN 332694
Overall star rating
1.0 of 5
Ownership
Profit
Certified
Mar 7, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
16

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

Locations

529 Beach 20th St
Ste 1
Far Rockaway, NY 11691
Phone (718) 327-4503

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

Affiliated clinicians 3

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": "1337299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342483200000",
    "number": "1194085662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 BEACH 20TH STREET",
            "address_2": "1ST FLOOR",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913645",
            "telephone_number": "718-327-4503",
            "fax_number": "718-327-0043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 BEACH 20TH ST",
            "address_2": "1ST FLOOR",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913645",
            "telephone_number": "718-327-7307",
            "fax_number": "718-327-3297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKAWAY HD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-18",
        "last_updated": "2012-07-17",
        "status": "A",
        "authorized_official_last_name": "OGUNFOWORA",
        "authorized_official_first_name": "OLUSEGUN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-327-4503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "206115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rockaway Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Far Rockaway, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; 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.