Wyota Dialysis, LLC

Primary specialty

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

Legal business name

WYOTA DIALYSIS, LLC

Practice address

11700 Livingston Rd
Fort Washington, MD 20744-5150

Phone

(301) 292-1804

Fax

(301) 292-9828

NPI assigned

Jul 25, 2018

Organization subpart

No

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

Authorized official

Name

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Livingston Village Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Listed as

DaVita Livingston Village DialysisCCN 212737

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Oct 21, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

19

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

CLIA laboratory certificates

Member of 1

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

• Renal Treatment Centers Mid Atlantic Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Goldsboro, NC
  • NPI 1174086698

  Member Of

  NPD member

Locations

Affiliated clinicians 3

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

• Mohammadali Anwar

  • Nephrology Physician
  • White Plains, MD
  • NPI 1700269230

  Dialysis facility

  Care Compare affiliation Name & address match
• Eric Antwi-Donkor, MD

  • Nephrology Physician
  • Washington, DC
  • NPI 1629053848

  Dialysis facility

  Care Compare affiliation Name & address match
• Richard L Palmer, MD

  • Nephrology Physician
  • Washington, DC
  • NPI 1134206741

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1306323050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11700 LIVINGSTON RD",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207445150",
            "telephone_number": "301-292-1804",
            "fax_number": "301-292-9828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYOTA DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-25",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502430700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Livingston Village Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mischelle L Worsley
• Kristi Wray
• Jeffrey W Wright, PT
• Monica Wright
• Charmaine Anne Wynter, DDS
• You First Care Team LLC
• You Share We Share II, LLC
• Charlena Young, CADII, CAC-AD
• Jessica Youra, MSW, BCBA
• Zamdds LLC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fort Washington, MD
• Providers in Fort Washington, MD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.