Isd Renal Inc

Primary specialty

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

Legal business name

ISD RENAL INC

Doing business as

Northridge Dialysis

Practice address

139 Market Place Dr
North Augusta, SC 29860-9274

Phone

(803) 279-2628

Fax

(803) 279-2578

NPI assigned

Jan 26, 2017

Organization subpart

No

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

Authorized official

Name

Mr. John Winstel

Title

Chief Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Northridge Dialysis Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285171454. Details of each certification follow.

• CCN 422669 End-stage renal disease facility · Active · Name & address match · Details

End-stage renal disease facility certification: CCN 422669

Legal name

NORTHRIDGE DIALYSIS

Certification status

Active

Provider type (POS)

End-stage renal disease facility

Participating since

Jul 19, 2018

Last certification

Jul 1, 2021

Ownership / control type

For Profit

Multi-facility organization

DAVITA INC

Facility address

139 Market Place Drive
North Augusta, SC 29860

Member of 1

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

• Dva Healthcare Renal Care Inc

  dba Three Chopt Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Richmond, VA
  • NPI 1154385375

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598832000000",
    "number": "1285171454",
    "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",
            "telephone_number": "615-320-4593",
            "fax_number": "800-293-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 MARKET PLACE DR",
            "city": "NORTH AUGUSTA",
            "state": "SC",
            "postal_code": "298609274",
            "telephone_number": "803-279-2628",
            "fax_number": "803-279-2578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISD RENAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-26",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RE0089",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northridge Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northridge Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Huntleigh Healthcare LLC
• Dawn Matee Hutto, DC
• Kandis Hutton
• Min Jung Hwang
• Illumination Psychiatry LLC
• J. William Thurmond III, MD LLC
• Kimberly Jackson
• Josef Beethoven Jacobson, D.P.T.
• Victoria James, RN
• Jeffrey N Broder MD (North Augusta Urgent Care Family & Occupational Medicine Center)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in North Augusta, SC
• Providers in North Augusta, SC by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.