NPIMap

Organization Active NPI

Dva Healthcare Southwest Ohio LLC

Doing business as Western Hills Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cincinnati, OH
National Provider Identifier
1245294412
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
0625DC Issued in OH
Legal business name
DVA HEALTHCARE SOUTHWEST OHIO LLC
Doing business as
Western Hills Dialysis
Practice address
3267 Westbourne Dr
Cincinnati, OH 45248-5110
Phone
(513) 347-0444
Fax
(513) 347-0150
NPI assigned
Apr 14, 2006
Last updated
Dec 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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 0625DC OH Primary

Addresses

Primary practice location

3267 Westbourne Dr
Cincinnati, OH 45248-5110

Mailing address

5200 Virginia Way
L&C Department
Brentwood, TN 37027-7569
Phone (615) 238-3051

Other identifiers 1

IdentifierTypeStateIssuer
2222222MedicaidOH

Other names 1

  • Western Hills Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030501000016 OH Part A Provider - End-Stage Renal Disease Facility (ESRD) 8820908668 Practice locations: Cincinnati, OH

Other NPIs with the same Medicare PAC ID 5

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

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
36D0974224Western Hills Dialysis3267 Westbourne Drive, Cincinnati, OH 45248Certificate of waiverMay 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Dva Healthcare Southwest Ohio LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member of 2

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

Member organizations 8

Organizations listed as members of this organization in the National Provider Directory.

Locations

3267 Westbourne Dr
Cincinnati, OH 45248
Phone (513) 347-0444

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1245294412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-238-3051",
            "fax_number": "800-246-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3267 WESTBOURNE DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452485110",
            "telephone_number": "513-347-0444",
            "fax_number": "513-347-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE SOUTHWEST OHIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "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": "OH",
            "license": "0625DC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2222222",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Hills Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western Hills Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.