NPIMap

Organization Active NPI

FMS Clyde Park South, LLC

Doing business as Fresenius Kidney Care Clyde Park South

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Grand Rapids, MI
National Provider Identifier
1245509348
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
FMS CLYDE PARK SOUTH, LLC
Doing business as
Fresenius Kidney Care Clyde Park South
Practice address
5311 Clyde Park Ave SW
Grand Rapids, MI 49509-9527
Phone
(616) 534-7179
Fax
(616) 534-7930
NPI assigned
Dec 19, 2011
Last updated
Oct 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Authorized official

Name
Barry L. Blanton
Title
Vice President
Phone
(781) 699-9000

Specialties & licenses 1

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

Addresses

Primary practice location

5311 Clyde Park Ave SW
Grand Rapids, MI 49509-9527

Mailing address

5311 Clyde Park Ave SW
Grand Rapids, MI 49509-9527
Phone (616) 534-7179

Other names 1

  • FRESENIUS KIDNEY CARE CLYDE PARK SOUTH Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

National Provider Directory

National Provider Directory
Tax ID family
Bio Med Applications of44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Member of 3

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

Locations

5311 Clyde Park Ave SW
Wyoming, MI 49509
Phone (615) 234-1188

NPI Registry JSON

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1245509348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5311 CLYDE PARK AVE SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495099527",
            "telephone_number": "616-534-7179",
            "fax_number": "616-534-7930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5311 CLYDE PARK AVE SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495099527",
            "telephone_number": "616-534-7179",
            "fax_number": "616-534-7930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMS CLYDE PARK SOUTH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2011-12-19",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "BLANTON",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "781-699-9000"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "FRESENIUS KIDNEY CARE CLYDE PARK SOUTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.