NPIMap

Organization Active NPI

Renal Treatment Centers-Southeast, LP.

Doing business as Brewton Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Brewton, AL
National Provider Identifier
1336483478
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
S2704 Issued in AL
Legal business name
RENAL TREATMENT CENTERS-SOUTHEAST, LP.
Doing business as
Brewton Dialysis
Practice address
1023 Douglas Ave Ste 300
Brewton, AL 36426-1568
Phone
(251) 867-8509
Fax
(251) 867-7325
NPI assigned
Nov 15, 2012
Last updated
Apr 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 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 S2704 AL Primary

Addresses

Primary practice location

1023 Douglas Ave Ste 300
Brewton, AL 36426-1568

Mailing address

5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
156807MedicaidAL

Other names 1

  • Brewton Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160122002089 AL Part A Provider - End-Stage Renal Disease Facility (ESRD) 1658555255 Practice locations: Brewton, AL

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Brewton DialysisCCN 012665
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Jul 31, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
10

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
01D2054751Brewton Dialysis1023 Douglas Ave Ste 300, Brewton, AL 36426Certificate of waiverFeb 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Bradley County Dialysis137 organizations share this tax ID, including this one

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 5

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": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1336483478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "1023 DOUGLAS AVE STE 300",
            "city": "BREWTON",
            "state": "AL",
            "postal_code": "364261568",
            "telephone_number": "251-867-8509",
            "fax_number": "251-867-7325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-SOUTHEAST, LP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "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": "AL",
            "license": "S2704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156807",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brewton Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brewton Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brewton, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.