Bluegrass Dialysis LLC

Primary specialty

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

License

300202 Issued in KY

Legal business name

BLUEGRASS DIALYSIS LLC

Doing business as

Williamstown Dialysis

Practice address

103 Barnes Rd
Ste a
Williamstown, KY 41097-9468

Phone

(859) 823-0500

Fax

(859) 823-0588

NPI assigned

Apr 11, 2008

Last updated

Oct 15, 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

• Williamstown Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Bluegrass Dialysis LLC

  dba 12th Street Covington Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Covington, KY
  • NPI 1255566444

  8921174517

  Same PAC ID

Listed as

DaVita Williamstown DialysisCCN 182595

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Oct 13, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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

CLIA laboratory certificates

Tax ID family

Bluegrass Dialysis LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Ohio River Dialysis LLC

  dba Turfway PD Training

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Florence, KY
  • NPI 1225249626
  NPD tax ID
• Ohio River Dialysis LLC

  dba Crestview Hills At Home

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Crestview Hills, KY
  • NPI 1437349685
  NPD tax ID
• River Valley Dialysis LLC

  dba Turfway Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Florence, KY
  • NPI 1841379922
  NPD tax ID

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• St Elizabeth Medical Center Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Williamstown, KY
  • NPI 1326590852

  Member Of

  NPD member
• Dva Renal Healthcare Inc

  dba Florissant Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1740241454

  Member Of

  NPD member
• Total Renal Care Inc

  dba Cerritos Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cerritos, CA
  • NPI 1255681011

  Member Of

  NPD member

Locations

Affiliated clinicians 1

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

• Emily Sue Kenner, M.D.

  • Nephrology Physician
  • Edgewood, KY
  • NPI 1225201858

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1194998013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "103 BARNES RD",
            "address_2": "STE A",
            "city": "WILLIAMSTOWN",
            "state": "KY",
            "postal_code": "410979468",
            "telephone_number": "859-823-0500",
            "fax_number": "859-823-0588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-11",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "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": "KY",
            "license": "300202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100061350",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williamstown Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Williamstown Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rhonda Asher, B.S.
• Back in Line Family Chiropractic PSC Inc
• Barry Baker, SLP
• Diane Beal
• Payton Malone Bloomer, MD
• Bluegrass Orthotics, LLC
• Paula Brun, MSW, LCSW
• Bryan Fallis (Progressive Podiatry)
• Brennan Christopher Burke, MD
• Maria Caldwell, APRN

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Williamstown, KY
• Providers in Williamstown, KY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.