Active NPI
Dva Renal Healthcare Inc
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Little Rock, AR
National Provider Identifier
1376516039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- DVA RENAL HEALTHCARE INC
- Practice address
- 6 Freeway Dr
Ste 100
Little Rock, AR 72204-2486 - Phone
- (501) 664-6754
- Fax
- (501) 296-9942
- NPI assigned
- Feb 10, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Samuel T Wey, AO
- Title
- VP, Licensure & Certification
- Phone
- (615) 341-6641
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Primary |
Addresses
Primary practice location
6 Freeway Dr
Ste 100
Little Rock, AR 72204-2486
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1501611 | Medicaid | LA | |
| 02529000 | Medicaid | NY | |
| 503272502 | Medicaid | MO | |
| 150329734 | Medicaid | AR | |
| 0042571 | Medicaid | TN | |
| 02520061 | Medicaid | MS |
Other names 1
- Central Little Rock Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030508000049 | AR | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 0840107611 | Practice locations: Little Rock, AR |
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita Central Little Rock Dialysis
- Overall star rating
- Ownership
- Profit
- Certified
- Mar 1, 2003
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 20
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 NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D1004570 | Central Little Rock Dialysis | Certificate of waiver | Sep 30, 2026 |
National Provider Directory
National Provider Directory- Tax ID family
- Gambro Healthcare Anahe
Practitioners & affiliated clinicians
Affiliated clinicians 6
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": "1139529600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1784505600000",
"number": "1376516039",
"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": "6 FREEWAY DR",
"address_2": "STE 100",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722042486",
"telephone_number": "501-664-6754",
"fax_number": "501-296-9942"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DVA RENAL HEALTHCARE INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-10",
"last_updated": "2026-07-20",
"certification_date": "2026-07-20",
"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",
"authorized_official_credential": "AO"
},
"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": "1501611",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02529000",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "503272502",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "150329734",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0042571",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02520061",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Central Little Rock Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Central Little Rock Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; 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.