NPIMap

Organization Active NPI

Dialyze Direct Il LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Glen Ellyn, IL
National Provider Identifier
1265903876
Registry record updated Sep 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DIALYZE DIRECT IL LLC
Practice address
800 Roosevelt Rd Ste E320
Glen Ellyn, IL 60137-5893
Phone
(732) 806-9968
NPI assigned
Dec 7, 2018
Last updated
Sep 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2019

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

Authorized official

Name
Joshua Rothenberg
Title
Chief Operating Officer
Phone
(732) 806-9968

Specialties & licenses 1

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

Addresses

Primary practice location

800 Roosevelt Rd Ste E320
Glen Ellyn, IL 60137-5893

Mailing address

3297 State Route 66
Neptune, NJ 07753-2762
Phone (732) 806-9968

Other names 1

  • Dialyze Direct IL - Glen Ellyn Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190307002733 IL Part A Provider - End-Stage Renal Disease Facility (ESRD) 7315286424 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oak Park, IL
O20190311002352 IL Part A Provider - End-Stage Renal Disease Facility (ESRD) 7315286424 Practice locations: Glen Ellyn, IL

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Dialyze Direct Il - Glen EllynCCN 142752
Ownership
Profit
Certified
May 17, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
1

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Affiliated clinicians 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1544140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568678400000",
    "number": "1265903876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3297 STATE ROUTE 66",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077532762",
            "telephone_number": "732-806-9968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ROOSEVELT RD STE E320",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375893",
            "telephone_number": "732-806-9968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYZE DIRECT IL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-07",
        "last_updated": "2019-09-17",
        "status": "A",
        "authorized_official_last_name": "ROTHENBERG",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "732-806-9968"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dialyze Direct IL - Glen Ellyn",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Glen Ellyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; 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.