Roushe Dialysis LLC

Primary specialty

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

Legal business name

ROUSHE DIALYSIS LLC

Doing business as

Mishawaka Dialysis

Practice address

1420 Trinity PL
Mishawaka, IN 46545-5005

Phone

(574) 231-7204

Fax

(574) 231-7205

NPI assigned

Jul 17, 2013

Last updated

May 23, 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 T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mishawaka Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Tax ID family

Mishawaka Dialysis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Total Renal Care Inc

  dba Mishawaka Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Mishawaka, IN
  • NPI 1932451671
  NPD tax ID

Member of 1

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

• Total Renal Care Inc

  dba Parkland Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Parkland, WA
  • NPI 1881987485

  Member Of

  NPD member

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

{
    "created_epoch": "1374019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1376984443",
    "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": "1420 TRINITY PL",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465455005",
            "telephone_number": "574-231-7204",
            "fax_number": "574-231-7205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUSHE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-17",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "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": "201228810A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mishawaka Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mishawaka Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• April Lynn Root, RD
• Anaya Roschyk
• Nicole E Rose
• Amy A Rosen, LMHC
• Jacob Roshanmanesh
• Steven A. Rowe
• Carol Ann Royer, M.D.
• April Rozycki, FNP-BC
• Todd W Rozycki, MD
• Ellis David Rudan Jr.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.