NPIMap

Organization Active NPI

Renal Treatment Centers - Mid-Atlantic, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bowie, MD
National Provider Identifier
1194785907
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E2626 Issued in MD
Legal business name
RENAL TREATMENT CENTERS - MID-ATLANTIC, INC.
Practice address
4861 Telsa Dr
Stes G, H, J
Bowie, MD 20715-4318
Phone
(301) 809-5342
Fax
(301) 809-5539
NPI assigned
Mar 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

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 E2626 MD Primary

Addresses

Primary practice location

4861 Telsa Dr
Stes G, H, J
Bowie, MD 20715-4318

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
4068327 00MedicaidMD

Other names 1

  • Renal Care of Bowie Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040813000516 TX Part A Provider - End-Stage Renal Disease Facility (ESRD) 4587572383 Practice locations: Bowie, MD

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Renal Care of BowieCCN 212626
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Aug 5, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
24

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 NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D1008501Renal Care of Bowie4861 Telsa Drive Suite G-H, Bowie, MD 20715Certificate of waiverJan 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Renal Treatment Centers Mid Atlantic Inc80 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Locations

4861 Tesla Dr
Ste G
Bowie, MD 20715
Phone (301) 809-5342

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1194785907",
    "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": "4861 TELSA DR",
            "address_2": "STES G, H, J",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207154318",
            "telephone_number": "301-809-5342",
            "fax_number": "301-809-5539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS - MID-ATLANTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "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": "MD",
            "license": "E2626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4068327 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renal Care of Bowie",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renal Care of Bowie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.