NPIMap

Organization Active NPI

Advanced Dialysis Center, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Easton, MD
National Provider Identifier
1255787115
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E2649 Issued in MD
Legal business name
ADVANCED DIALYSIS CENTER, LLC
Practice address
610 Dutchmans LN
Easton, MD 21601-3346
Phone
(410) 820-9873
NPI assigned
May 10, 2016
Organization subpart
Yes
Parent organization
ADVANCED DIALYSIS CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Authorized official

Name
Mrs. Minessia Zarita Pearson, MSN
Title
Chief Financial Officer
Phone
(301) 577-1007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X E2649 MD Primary

Addresses

Primary practice location

610 Dutchmans LN
Easton, MD 21601-3346

Mailing address

9320 Annapolis Rd
Lanham, MD 20706-3100
Phone (301) 577-1007

Other identifiers 1

IdentifierTypeStateIssuer
4112326MedicaidMD

Other names 1

  • Advanced Dialysis Center Easton Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Lanham Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Advanced Dialysis Center3 organizations share this tax ID, including this one
Part of
Advanced Dialysis Center

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1255787115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9320 ANNAPOLIS RD",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063100",
            "telephone_number": "301-577-1007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 DUTCHMANS LN",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216013346",
            "telephone_number": "410-820-9873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DIALYSIS CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED DIALYSIS CENTER, LLC",
        "enumeration_date": "2016-05-10",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "PEARSON",
        "authorized_official_first_name": "MINESSIA",
        "authorized_official_middle_name": "ZARITA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "301-577-1007",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MD",
            "license": "E2649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112326",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Lanham",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "610 Dutchmans Ln",
            "city": "Easton",
            "state": "MD",
            "country_code": "US",
            "postal_code": "216013346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Advanced Dialysis Center Easton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Easton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; 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.