Active NPI
Ut Southwestern Dva Healthcare LLP
Doing business as UT Southwestern Dallas Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Irving, TX
National Provider Identifier
1336103902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- 000202
- Legal business name
- UT SOUTHWESTERN DVA HEALTHCARE LLP
- Doing business as
- UT Southwestern Dallas Dialysis
- Practice address
- 204 E Airport Fwy
Irving, TX 75062-6305 - Phone
- (972) 438-7375
- Fax
- (972) 554-1489
- NPI assigned
- Apr 12, 2006
- Last updated
- Jan 22, 2025
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 000202 | TX | Primary |
Addresses
Primary practice location
204 E Airport Fwy
Irving, TX 75062-6305
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 087904101 | Medicaid | TX |
Other names 1
- UT Southwestern Dallas Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030509000004 | TX | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 4284544925 | Practice locations: Irving, TX |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Dallas East Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Dallas, TX
- NPI 1073576021
4284544925
-
dba UT Southwestern Oakcliff Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Dallas, TX
- NPI 1649234212
4284544925
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita UT Southwestern-Dallas Dialysis
- Overall star rating
- Ownership
- Profit
- Certified
- Jun 10, 1996
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 36
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 NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0924064 | Ut Southwestern Dva Healthcare | Certificate of waiver | Jan 16, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Dallas East Dialysis
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Dallas East Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Dallas, TX
- NPI 1073576021
-
dba UT Southwestern Oakcliff Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Dallas, TX
- NPI 1649234212
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Durham West Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Durham, NC
- NPI 1275592602
Member Of
Practitioners & affiliated clinicians
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": "1144800000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1737504000000",
"number": "1336103902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5200 VIRGINIA WAY",
"address_2": "L&C DEPT",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370277569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 E AIRPORT FWY",
"city": "IRVING",
"state": "TX",
"postal_code": "750626305",
"telephone_number": "972-438-7375",
"fax_number": "972-554-1489"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UT SOUTHWESTERN DVA HEALTHCARE LLP",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-12",
"last_updated": "2025-01-22",
"certification_date": "2025-01-22",
"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": "TX",
"license": "000202",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "087904101",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "UT Southwestern Dallas Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "UT Southwestern Dallas Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Irving, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.