NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

Doing business as Mint Hill Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Mint Hill, NC
National Provider Identifier
1205116167
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DVA HEALTHCARE RENAL CARE INC
Doing business as
Mint Hill Dialysis
Practice address
11308 Hawthorne Dr
Mint Hill, NC 28227-9300
Phone
(704) 573-2549
Fax
(704) 545-3747
NPI assigned
Aug 24, 2011
Last updated
Aug 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Authorized official

Name
Samuel T Wey
Title
Sr Director,Licensure&Certification
Phone
(615) 341-6641

Specialties & licenses 1

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

Addresses

Primary practice location

11308 Hawthorne Dr
Mint Hill, NC 28227-9300

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4593

Other identifiers 1

IdentifierTypeStateIssuer
1205116167MedicaidNC

Other names 1

  • Mint Hill Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120309000240 NC Part A Provider - End-Stage Renal Disease Facility (ESRD) 7517875545 Practice locations: Mint Hill, NC

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
34D2046061Mint Hill Dialysis11308 Hawthorne Dr, Mint Hill, NC 28227Certificate of waiverAug 23, 2026

National Provider Directory

National Provider Directory
Tax ID family
Community Dialysis Services194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1205116167",
    "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": "615-320-4593",
            "fax_number": "800-293-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11308 HAWTHORNE DR",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282279300",
            "telephone_number": "704-573-2549",
            "fax_number": "704-545-3747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-24",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR DIRECTOR,LICENSURE&CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205116167",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mint Hill Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mint Hill Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mint Hill, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; 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.