Renviva Dialysis Center of Eastern Panhandle, LLC

Primary specialty

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

Legal business name

RENVIVA DIALYSIS CENTER OF EASTERN PANHANDLE, LLC

Practice address

91 Sugar Hollow Rd Ste E
Berkeley Springs, WV 25411-7243

Phone

(304) 944-7004

NPI assigned

Aug 29, 2023

Organization subpart

No

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

Authorized official

Name

Akinyinka Awosika

Title

Member Manager

Phone

(321) 710-0352

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Listed as

Renvivia Dialysis Center of Eastern Panhandle LLCCCN 512553

Ownership

Profit

Certified

May 1, 2024

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

2

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

CLIA laboratory certificates

Practitioners 3

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

• Bethune Alafia Grindley, M.D.

  • Nephrology Physician
  • Winchester, VA
  • NPI 1992130983
  NPD
• Banji O Awosika, MD

  • Specialist
  • Winter Garden, FL
  • NPI 1295770428
  NPD (past)
• Swetha Makkapati

  • Nephrology Physician
  • Winchester, VA
  • NPI 1629335880
  NPD (past)

Affiliated clinicians 1

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

• Babak Barmar, MD

  • Nephrology Physician
  • Martinsburg, WV
  • NPI 1972667202

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1295510071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 SUGAR HOLLOW RD STE E",
            "city": "BERKELEY SPRINGS",
            "state": "WV",
            "postal_code": "254117243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 SUGAR HOLLOW RD STE E",
            "city": "BERKELEY SPRINGS",
            "state": "WV",
            "postal_code": "254117243",
            "telephone_number": "304-944-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENVIVA DIALYSIS CENTER OF EASTERN PANHANDLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-29",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "AWOSIKA",
        "authorized_official_first_name": "AKINYINKA",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "321-710-0352"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mollie Gracelyn Rebuck
• Diane M Redick, RPH
• Kenneth R Reed, R.PH.
• Tally R Reed, R.PH.
• Reeds Pharmacy LLC
• Ginger Reynolds
• Kristi Lynn Riggleman
• Brianna Corrinne Roach, NP
• Jenny Roberts
• Pierre Roberts

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Berkeley Springs, WV
• Providers in Berkeley Springs, WV by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; 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.