Dva Healthcare of Norwich LLC

Primary specialty

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

License

0279 Issued in CT

Legal business name

DVA HEALTHCARE OF NORWICH LLC

Doing business as

Norwich Dialysis

Practice address

113 Salem Tpke Ste 4
Norwich, CT 06360-6484

Phone

(860) 800-6388

Fax

(860) 800-6425

NPI assigned

Feb 23, 2006

Last updated

Nov 13, 2024By the provider in NPPES

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

• Norwich Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Listed as

DaVita Norwich DialysisCCN 072520

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Nov 1, 1999

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

28

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 2

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

• The William W Backus Hospital

  • General Acute Care Hospital
  • Norwich, CT
  • NPI 1639135718

  Member Of

  NPD member
• Dva Renal Healthcare Inc

  dba Florissant Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1740241454

  Member Of

  NPD member

Locations

Affiliated clinicians 4

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

• Mihaela Olivia Negulescu, MD

  • Nephrology Physician
  • Uncasville, CT
  • NPI 1558473801

  Dialysis facility

  Care Compare affiliation Name & address match
• Thomas C Peter, MD

  • Nephrology Physician
  • Uncasville, CT
  • NPI 1952397549

  Dialysis facility

  Care Compare affiliation Name & address match
• Altaf Rasool, M.D

  • Nephrology Physician
  • Uncasville, CT
  • NPI 1013018357

  Dialysis facility

  Care Compare affiliation Name & address match
• Mary Rose Gotardo Tantoco, M.D.

  • Nephrology Physician
  • Uncasville, CT
  • NPI 1336315969

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1255307039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "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": "113 SALEM TPKE STE 4",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063606484",
            "telephone_number": "860-800-6388",
            "fax_number": "860-800-6425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE OF NORWICH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "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": "CT",
            "license": "0279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004206620",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Norwich Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Norwich Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robb F Dunn, LMSW
• Michael Edmund Dunne, D.M.D.
• Michelene Marie Dupuis
• Poovitha Durairaj
• Stephanie Dutton
• Alison Dvorak, MS, RDN, CDN
• Lori Ann Dvorak, LCSW
• Alison Leah Dwyer, APRN
• Jemel Desmond Dyer
• Carol Dyson, LCSW

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Norwich, CT
• Providers in Norwich, CT by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; 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.