Davita Dakota Dialysis Center LLC

Primary specialty

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

Legal business name

DAVITA DAKOTA DIALYSIS CENTER LLC

Practice address

4474 23Rd Ave S
Ste M
Fargo, ND 58104-8795

Phone

(701) 281-3900

Fax

(701) 282-2635

NPI assigned

Aug 5, 2007

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Fargo Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Listed as

DaVita Fargo Dialysis CenterCCN 352502

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Nov 15, 2007

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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

CLIA laboratory certificates

Member of 2

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

• Renal Treatment Centers West Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Oklahoma City, OK
  • NPI 1124509245

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Affiliated clinicians 3

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

• Marwan M.B. Abu Minshar, M.D.

  • Nephrology Physician
  • Fargo, ND
  • NPI 1093096406

  Dialysis facility

  Care Compare affiliation Name & address match
• Hassan Bin Attique, M.D.

  • Nephrology Physician
  • Fargo, ND
  • NPI 1033562525

  Dialysis facility

  Care Compare affiliation Name & address match
• Mita Zahra Estrada Co, M.D.

  • Nephrology Physician
  • Langhorne, PA
  • NPI 1851742423

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1356532550",
    "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": "4474 23RD AVE S",
            "address_2": "STE M",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048795",
            "telephone_number": "701-281-3900",
            "fax_number": "701-282-2635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVITA DAKOTA DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1453372",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fargo Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fargo Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Moriah Davis
• Nathan Archie Davis
• Sara Davis
• Victoria Ann Davis
• Laura J. Davison, L.S.W.
• Fawad Dawlaty
• Brian Jefferson Dawson, MD
• Day Dental PC
• Jolene Day, PHARM. D.
• Kathleen Ann Day, DPT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fargo, ND
• Providers in Fargo, ND by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.