Nicona Dialysis LLC

Primary specialty

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

Legal business name

NICONA DIALYSIS LLC

Doing business as

Brodie Lane Dialysis

Practice address

9010 Brodie Lane
BLDG a
Austin, TX 78748-5184

Phone

(512) 280-6505

Fax

(512) 280-6866

NPI assigned

May 21, 2019

Last updated

Feb 20, 2025By 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 T Wey

Title

VP Licensure&Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brodie Lane Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

DaVita Brodie Lane DialysisCCN 742555

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Dec 2, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

14

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 1

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

• Renal Treatment Centers-Southeast, LP.

  dba Barbour County Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Eufaula, AL
  • NPI 1326583188

  Member Of

  NPD member

Locations

Affiliated clinicians 3

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

• Tessa Kimberly Novick, M.D., M.S.W

  • Nephrology Physician
  • Austin, TX
  • NPI 1881039568

  Dialysis facility

  Care Compare affiliation Name & address match
• Nicholas James Rowder, MD

  • Nephrology Physician
  • Austin, TX
  • NPI 1942230164

  Dialysis facility

  Care Compare affiliation Name & address match
• Vincent M. Tjia, MD

  • Nephrology Physician
  • Austin, TX
  • NPI 1306803937

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1558396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740009600000",
    "number": "1376100818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9010 BRODIE LANE",
            "address_2": "BLDG A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787485184",
            "telephone_number": "512-280-6505",
            "fax_number": "512-280-6866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICONA DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-21",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "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": "4087009-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brodie Lane Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brodie Lane Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Bailey Nicol, M.D.
• Christine Nicola, NP
• Nicolas Carrasco, PHD., Inc.
• Nicole Smith Speech and Language Therapy, PLLC (Sago Speech Therapy)
• Nicole Williams Counseling
• Gail Nicosia, D.D.S.
• Jordan Swindle Nicquette, PA
• Julie Niedert, M.S., CCC-SLP
• Joy Nielsen, M.D.
• Kristian Thomas Nielsen, CRNA

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Austin, TX
• Providers in Austin, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; 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.