Isd Renal Inc

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

ISD RENAL INC

Doing business as

Mallory Park Dialysis

Practice address

2808 Germantown St
Dayton, OH 45417-4134

Phone

(937) 262-8427

Fax

(937) 262-8016

NPI assigned

Dec 2, 2016

Last updated

Jun 6, 2024By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Mallory Park Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Other NPIs with the same Medicare PAC ID 24

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

• Isd Renal Inc

  dba National Road Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bridgeport, OH
  • NPI 1205396744

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba Canton Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Canton, OH
  • NPI 1629596267

  6507053790

  Same PAC ID
• Isd Renal, Inc.

  dba Navarre Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Navarre, OH
  • NPI 1134615651

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba Foreman Drive Home Training

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cookeville, TN
  • NPI 1003390469

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba Greensboro Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Greensboro, GA
  • NPI 1073816914

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba Fairmount Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Philadelphia, PA
  • NPI 1134640949

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba Speedway Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Indianapolis, IN
  • NPI 1174006662

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba North Providence Renal Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • North Providence, RI
  • NPI 1174579619

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba Merchantville Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pennsauken, NJ
  • NPI 1194230441

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba Cedar Grove Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Philadelphia, PA
  • NPI 1235795204

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba South Dean Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Englewood, NJ
  • NPI 1245891670

  6507053790

  Same PAC ID
• Isd Renal Inc

  dba Girard Estates Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Philadelphia, PA
  • NPI 1295344307

  6507053790

  Same PAC ID

Listed as

DaVita Mallory Park DialysisCCN 362860

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Oct 12, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

24

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

CLIA laboratory certificates

Tax ID family

Renal Care of Marion88 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 4

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

• Isd Renal Inc

  dba National Road Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bridgeport, OH
  • NPI 1205396744
  NPD tax ID
• Isd Renal Inc

  dba Akron Renal Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Akron, OH
  • NPI 1407992555
  NPD tax ID
• Isd Renal Inc

  dba Canton Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Canton, OH
  • NPI 1629596267
  NPD tax ID
• Isd Renal, Inc.

  dba Navarre Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Navarre, OH
  • NPI 1134615651
  NPD tax ID

Member of 2

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

• Dva Healthcare Renal Care Inc

  dba Amelia Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Amelia Court House, VA
  • NPI 1861456113

  Member Of

  NPD member
• Dva Renal Healthcare Inc

  dba Florissant Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1740241454

  Member Of

  NPD member

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Sampath Kumar Thiruveedi, M.D.

  • Nephrology Physician
  • Kettering, OH
  • NPI 1992938294

  Dialysis facility

  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717632000000",
    "number": "1336682707",
    "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": "2808 GERMANTOWN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454174134",
            "telephone_number": "937-262-8427",
            "fax_number": "937-262-8016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISD RENAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-02",
        "last_updated": "2024-06-06",
        "certification_date": "2024-05-30",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0253536",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mallory Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mallory Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tyesha Irvin
• Ashley M Irvine, LSW
• Obimba Benneth Isaac, PHARM.D
• Elizabeth Isaacs
• Isabella Hammonds Estate (Isabella's Bra-tique)
• Scott Isgrigg
• Ahmad Iskandarani
• Omar Iskandarani, DO
• Zaher Iskandarani, MD
• Gulsara Iskandarova

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Dayton, OH
• Providers in Dayton, OH by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.