Nra-Crossville, Tennessee, LLC

Primary specialty

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

License

0000000148 Issued in TN

Legal business name

NRA-CROSSVILLE, TENNESSEE, LLC

Practice address

121 Dooley St
Crossville, TN 38555-4075

Phone

(931) 484-4500

Fax

(931) 484-2130

NPI assigned

May 30, 2006

Organization subpart

Yes

Parent organization

FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

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

Authorized official

Name

Barry Blanton

Title

Vice President

Phone

(781) 699-9000

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Crossville Dialysis Clinic Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

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).

• Nra-Crossville, Tennessee, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Crossville, TN
  • NPI 1033860481

  5092771758

  Same PAC ID

Tax ID family

Ability Network2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Nra-Crossville, Tennessee, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Crossville, TN
  • NPI 1033860481
  NPD tax ID

Member of 1

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

• National Medical Care, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bristol, TN
  • NPI 1477570117

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1265489686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 DOOLEY ST",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554075",
            "telephone_number": "931-484-4500",
            "fax_number": "931-484-2130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 DOOLEY ST",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554075",
            "telephone_number": "931-484-4500",
            "fax_number": "931-484-2130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NRA-CROSSVILLE, TENNESSEE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2006-05-30",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "BLANTON",
        "authorized_official_first_name": "BARRY",
        "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": "TN",
            "license": "0000000148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0442656",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATE OF WAIVE",
            "identifier": "44D1034070",
            "state": "TN"
        }
    ],
    "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": "Crossville Dialysis Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crossville Dialysis Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dorota Julita Nosarzewska, PTA
• Tomasz J Nosarzewski, PT
• NP Enterprises Inc
• NP Enterprises, Inc.
• Nra-Crossville, Tennessee, LLC
• Nurseride LLC
• Erin Oconnell, FNP-C, RN
• Reynaldo A Olaechea, MD
• Charles Olsen, NP
• Andrea Olson, OTR/L

• All providers in Crossville, TN
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.