NPIMap

Organization Active NPI

Northwest Detroit Dialysis Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Southfield, MI
National Provider Identifier
1295047710
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
B8672P Issued in MI
Legal business name
NORTHWEST DETROIT DIALYSIS CENTER LLC
Practice address
21000 Northwestern Hwy
Southfield, MI 48075-5306
Phone
(248) 557-7000
Fax
(248) 557-7786
NPI assigned
Jul 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

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

Authorized official

Name
Mr. David F Shepherd
Title
Vice President
Phone
(248) 642-5038

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X B8672P MI Primary

Addresses

Primary practice location

21000 Northwestern Hwy
Southfield, MI 48075-5306

Mailing address

30100 Telegraph Rd
Ste 200
Bingham Farms, MI 48025-4516
Phone (248) 642-5038

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101106000021 MI Part A Provider - End-Stage Renal Disease Facility (ESRD) 8527978675 Practice locations: Southfield, MI

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Greenfield HS - Northland ParkCCN 232670
Overall star rating
2.0 of 5
Ownership
Profit
Certified
May 2, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Greenfield Health Systems
Dialysis stations
30

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
Tax ID family
Northwest Detroit Dialysis Center LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

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

NPI Registry JSON

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

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1295047710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30100 TELEGRAPH RD",
            "address_2": "STE 200",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254516",
            "telephone_number": "248-642-5038",
            "fax_number": "248-642-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21000 NORTHWESTERN HWY",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755306",
            "telephone_number": "248-557-7000",
            "fax_number": "248-557-7786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST DETROIT DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-13",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "248-642-5038",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MI",
            "license": "B8672P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; 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.