NPIMap

Organization Active NPI

Renal Treatment Centers - Mid-Atlantic, Inc.

Doing business as Macland Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Powder Springs, GA
National Provider Identifier
1306362660
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
RENAL TREATMENT CENTERS - MID-ATLANTIC, INC.
Doing business as
Macland Dialysis
Practice address
4110 Austell Powder Springs Rd Ste 100
Powder Springs, GA 30127-2954
Phone
(770) 439-8775
Fax
(770) 439-8736
NPI assigned
Aug 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Authorized official

Name
Samuel Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

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

Addresses

Primary practice location

4110 Austell Powder Springs Rd Ste 100
Powder Springs, GA 30127-2954

Mailing address

5200 Virginia Way
L & C Departmernt
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
003208460AMedicaidGA

Other names 1

  • Macland Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180104000936 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4587572383 Practice locations: Powder Springs, GA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita MacLand DialysisCCN 852546
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Jul 3, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
17

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2140002Macland Dialysis4110 Austell Powder Springs Road, Suite 100, Powder Springs, GA 30127Certificate of waiverNov 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Renal Treatment Centers Mid Atlantic Inc80 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Locations

4110 Austell Powder Springs Rd
Ste 100
Powder Springs, GA 30127
Phone (770) 439-8775

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1306362660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L & C DEPARTMERNT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 AUSTELL POWDER SPRINGS RD STE 100",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301272954",
            "telephone_number": "770-439-8775",
            "fax_number": "770-439-8736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS - MID-ATLANTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": "003208460A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Macland Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Powder Springs, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.