Advanced Dialysis Center, LLC

Primary specialty

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

Legal business name

ADVANCED DIALYSIS CENTER, LLC

Doing business as

Advanced Dialysis Center Crofton

Practice address

2131 Davidsonville Rd
Crofton, MD 21114-1632

Phone

(301) 577-1007

NPI assigned

Jan 22, 2020

Last updated

Jan 22, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

ADVANCED DIALYSIS CENTER, LLCAs reported in NPPES

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

Authorized official

Name

Mary Hayes Jenkins, RN

Title

Ceo

Phone

(301) 577-1007

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Advanced Dialysis Center Crofton Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Advanced Dialysis Center, LLC

  dba Advanced Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1508029372

  9032188131

  Same PAC ID

Listed as

Advanced Dialysis Center-CroftonCCN 212741

Ownership

Profit

Certified

Mar 27, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

9

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Advanced Dialysis Center LLC3 organizations share this tax ID, including this one

Part of

Advanced Dialysis Center LLC

Other organizations with this tax ID 2

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

• Advanced Dialysis Center, LLC

  dba Advanced Dialysis Center Easton

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Easton, MD
  • NPI 1255787115
  NPD tax ID
• Advanced Dialysis Center, LLC

  dba Advanced Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1508029372
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Irmindra S Rana, MD

  • Nephrology Physician
  • Arlington, VA
  • NPI 1033130794
  NPD (past)

Affiliated clinicians 1

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

• Kryt Chattrabhuti, M.D.

  • Nephrology Physician
  • Annapolis, MD
  • NPI 1346683935

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579651200000",
    "number": "1265062954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9320 ANNAPOLIS RD STE 200",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063121",
            "telephone_number": "301-577-1007",
            "fax_number": "301-577-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 DAVIDSONVILLE RD",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211141632",
            "telephone_number": "301-577-1007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DIALYSIS CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED DIALYSIS CENTER, LLC",
        "enumeration_date": "2020-01-22",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "HAYES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-577-1007",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4220242",
            "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": "2131 Davidsonville Rd",
            "city": "Crofton",
            "state": "MD",
            "country_code": "US",
            "postal_code": "211141632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Advanced Dialysis Center Crofton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Crofton, MD
• Providers in Crofton, MD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.