NPIMap

Organization Active NPI

Dva Healthcare of Massachusetts Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Medford, MA
National Provider Identifier
1205415593
Registry record updated Apr 7, 2025
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 OF MASSACHUSETTS INC
Practice address
712 Fellsway
Medford, MA 02115
Phone
(781) 957-4032
Fax
(781) 957-4050
NPI assigned
Apr 5, 2021
Organization subpart
Yes
Parent organization
DAVITA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

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 Primary

Addresses

Primary practice location

712 Fellsway
Medford, MA 02115

Mailing address

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

Other names 1

  • Mystic River Home Training Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230109002738 MA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9830007202 Practice locations: Medford, MA

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Dva Healthcare of Massachusetts Inc11 organizations share this tax ID, including this one
Part of
Davita Inc

Other organizations with this tax ID 10

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

Locations

330 Brookline Ave
Bldg GZ5
Boston, MA 02215
Phone (617) 667-3211

712 Fellsway
Medford, MA 02155
Phone (781) 957-4032

10 Cabot Rd
Ste 103B
Medford, MA 02155
Phone (781) 306-9740

524 Union St
New Bedford, MA 02740
Phone (508) 675-2840

207 Highland Ave
Ste 205
Salem, MA 01970
Phone (978) 744-2075

10 Colonial Rd
Ste 205
Salem, MA 01970
Phone (978) 744-3660

330 Libbey Industrial Pkwy
Ste 900
Weymouth, MA 02189
Phone (781) 331-7700

267 Shrewsbury St
Worcester, MA 01604
Phone (774) 530-6353

NPI Registry JSON

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1205415593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L AND C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 FELLSWAY",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "02115",
            "telephone_number": "781-957-4032",
            "fax_number": "781-957-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE OF MASSACHUSETTS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAVITA INC",
        "enumeration_date": "2021-04-05",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mystic River Home Training",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mystic River Home Training",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.