NPIMap

Organization Active NPI

Dialysis Clinic Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Phenix City, AL
National Provider Identifier
1366462772
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
07985 Issued in AL
Legal business name
DIALYSIS CLINIC INC.
Practice address
1611 21St Court
Phenix City, AL 36867
Phone
(334) 448-4840
Fax
(334) 448-4430
NPI assigned
Jul 20, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Donovan Schultz
Title
President
Phone
(615) 327-3061

Corporate family (same tax ID) 14

Organizations that report the same tax identification number in the National Provider Directory.

Affiliated clinicians 1

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Dci Phenix CityCCN 012598
Overall star rating
1.0 of 5
Ownership
Profit
Certified
Feb 9, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Dialysis Clinic, Inc.
Dialysis stations
12

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
01D0968024Dialysis Clinic Inc1611 21St Court, Phenix City, AL 36867Certificate of waiverJan 4, 2028

Medicare participation

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

All facility ownership & control disclosures 1

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rancho Dialysis ClinicSacramento, CA, CCN 552519 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 24, 2003
Dec 24, 2003

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20080602000182 AL Part a Provider - End-Stage Renal Disease Facility (ESRD) 4284541129 Practice locations: Phenix City, AL

National Provider Directory

National Provider Directory
Tax ID family
Elbert P Tuttle Jr MD (238 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 07985 AL Primary

Addresses

NPPES NPI Registry

Primary practice location

1611 21St Court
Phenix City, AL 36867

Mailing address

1611 21St Court
Phenix City, AL 36867
Phone (334) 448-4840

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
DIA2598DMedicaidAL
053249301AMedicaidGA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 4, 2023.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1366462772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 21ST COURT",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "36867",
            "telephone_number": "334-448-4840",
            "fax_number": "334-448-4430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 21ST COURT",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "36867",
            "telephone_number": "334-448-4840",
            "fax_number": "334-448-4430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DONOVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-327-3061",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "AL",
            "license": "07985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DIA2598D",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053249301A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phenix City, AL

Sources for this page

Verify at the official NPI Registry.