NPIMap

Organization Active NPI

Dialysis Centers of Northwest Arkansas, LLC

Doing business as Benton County Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bentonville, AR
National Provider Identifier
1336220250
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLC
Doing business as
Benton County Dialysis Center
Practice address
801 SE Plaza Ave
Suite 1
Bentonville, AR 72712-7772
Phone
(479) 273-7340
NPI assigned
Oct 18, 2006
Last updated
Mar 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Authorized official

Name
Robert S Bomstad
Title
Administrator and Ceo
Phone
(479) 463-7000

Specialties & licenses 1

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

Addresses

Primary practice location

801 SE Plaza Ave
Suite 1
Bentonville, AR 72712-7772

Mailing address

801 SE Plaza Ave
Suite 1
Bentonville, AR 72712-7772
Phone (479) 273-7340

Other names 1

  • Benton County Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050314000700 AR Part A Provider - End-Stage Renal Disease Facility (ESRD) 6800840802 1 other NPI on this enrollment
Practice locations: Bentonville, AR

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Benton County Dialysis CtrCCN 042575
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Sep 9, 2005
Medicare certification status
ActiveFrom the Provider of Services file
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
04D1037079Benton County Dialysis Center801 SE Plaza Avenue Suite 1, Bentonville, AR 72712Certificate of waiverFeb 14, 2027

National Provider Directory

National Provider Directory

Member of 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 6

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": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1336220250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SE PLAZA AVE",
            "address_2": "SUITE 1",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127772",
            "telephone_number": "479-273-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 SE PLAZA AVE",
            "address_2": "SUITE 1",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127772",
            "telephone_number": "479-273-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "BOMSTAD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR AND CEO",
        "authorized_official_telephone_number": "479-463-7000"
    },
    "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": "Benton County Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; 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.