Freeportbay Dialysis LLC

Primary specialty

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

Legal business name

FREEPORTBAY DIALYSIS LLC

Practice address

1808 S West Ave
Freeport, IL 61032-6712

Phone

(815) 232-0295

Fax

(815) 232-1635

NPI assigned

Feb 9, 2012

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

• Driftwood Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

DaVita Driftwood DialysisCCN 142747

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Oct 15, 2012

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

Member of 1

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

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Affiliated clinicians 3

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

• Farhan A Khan, MD

  • Nephrology Physician
  • Freeport, IL
  • NPI 1760593693

  Dialysis facility

  Care Compare affiliation Name & address match
• John C Maynard, MD

  • Nephrology Physician
  • Rockford, IL
  • NPI 1730180878

  Dialysis facility

  Care Compare affiliation Name & address match
• Charles M Stuart, MD

  • Nephrology Physician
  • Monroe, WI
  • NPI 1548227317

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743379200000",
    "number": "1225300056",
    "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": "1808 S WEST AVE",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610326712",
            "telephone_number": "815-232-0295",
            "fax_number": "815-232-1635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEPORTBAY DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-09",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-27",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "=========",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Driftwood Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Driftwood Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Freeport Regional Health Care Foundation
• Freeport Regional Health Care Foundation
• Freeport Regional Health Care Services
• Freeport Regional Health Care Services
• Freeport Rural Fire Protection District
• Sherry D Gaddis
• Eugene Michael Gaertner, MD
• Maurine J. Galaway-Eden
• Cody W Gallagher, PT
• Stephanie Garner, LMT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Freeport, IL
• Providers in Freeport, IL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.