NPIMap

Organization Active NPI

Renal Treatment Centers - Mid-Atlantic, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Douglas, GA
National Provider Identifier
1316616519
Registry record updated Sep 10, 2021
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.
Practice address
1345 Bowens Mill Rd SE Ste D
Douglas, GA 31533-1534
Phone
(229) 635-6070
Fax
(229) 635-5439
NPI assigned
Sep 10, 2021
Organization subpart
Yes
Parent organization
DAVITA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Authorized official

Name
John Winstel
Title
Chief Accounting Officer
Phone
(253) 733-4501

Specialties & licenses 1

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

Addresses

Primary practice location

1345 Bowens Mill Rd SE Ste D
Douglas, GA 31533-1534

Mailing address

5200 Virginia Way
Brentwood, TN 37027-7569
Phone (615) 320-4283

Other names 1

  • Douglas Home Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220307000281 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4587572383 Practice locations: Douglas, GA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Douglas Home DialysisCCN 852590
Overall star rating
1.0 of 5
Ownership
Profit
Certified
May 31, 2022
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
2

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
11D2238264Douglas Home Dialysis1345 Bowens Mill Road, Suite D, Douglas, GA 31533Certificate of waiverSep 30, 2027

National Provider Directory

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

Organizations with this tax ID in the same state 16

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

View all 16

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1316616519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4283",
            "fax_number": "800-320-3933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 BOWENS MILL RD SE STE D",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315331534",
            "telephone_number": "229-635-6070",
            "fax_number": "229-635-5439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS - MID-ATLANTIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAVITA INC",
        "enumeration_date": "2021-09-10",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Douglas Home Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Douglas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.