NPIMap

Organization Active NPI

Saguaro Dialysis LLC

Doing business as Shelby County Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Shelbyville, KY
National Provider Identifier
1215309778
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
SAGUARO DIALYSIS LLC
Doing business as
Shelby County Dialysis
Practice address
50 Church View St
Shelbyville, KY 40065-1663
Phone
(502) 647-0127
Fax
(502) 633-4991
NPI assigned
Oct 23, 2015
Last updated
Feb 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 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 NU Primary

Addresses

Primary practice location

50 Church View St
Shelbyville, KY 40065-1663

Mailing address

5200 Virginia Way
Att: L&C Department
Brentwood, TN 37027-7569

Other names 1

  • Shelby County Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151221002733 KY Part A Provider - End-Stage Renal Disease Facility (ESRD) 0345541165 Practice locations: Shelbyville, KY

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Shelby County DialysisCCN 182635
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Feb 2, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
2

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
18D2107877Shelby County Dialysis50 Church View Street, Shelbyville, KY 40065Certificate of waiverJan 24, 2028

National Provider Directory

National Provider Directory

Member of 1

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

Locations

50 Church View St
Shelbyville, KY 40065
Phone (502) 647-0127

Practitioners & affiliated clinicians

Practitioners 8

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.

Affiliated clinicians 1

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": "1445558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1215309778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 CHURCH VIEW ST",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400651663",
            "telephone_number": "502-647-0127",
            "fax_number": "502-633-4991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGUARO DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-23",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelby County Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shelby County Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelbyville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; 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.