Liberty Dialysis - Kokomo LLC

Primary specialty

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

Legal business name

LIBERTY DIALYSIS - KOKOMO LLC

Doing business as

U.S. Renal Care Kokomo Dialysis

Practice address

3760 S Reed Rd
Kokomo, IN 46902-3829

Phone

(765) 864-1669

Fax

(765) 864-1758

NPI assigned

Jun 21, 2007

Organization subpart

Yes

Parent organization

U.S. RENAL CARE, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas L. Weinberg

Title

Authorized Official

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• U.S. Renal Care Kokomo Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

USRC Kokomo DialysisCCN 152617

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Oct 15, 2007

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

15

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

CLIA laboratory certificates

Part of

US Renal Care Inc

Member of 1

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

• Dialysis Newco LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Viera, FL
  • NPI 1982970554

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dawn Marie Sabau, MD

  • Nephrology Physician
  • Kokomo, IN
  • NPI 1053485367
  NPD (past)

Affiliated clinicians 3

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

• Dawn Marie Sabau, MD

  • Nephrology Physician
  • Kokomo, IN
  • NPI 1053485367

  Dialysis facility

  Care Compare affiliation Name & address match
• Alok Silodia, M.D.

  • Nephrology Physician
  • Indianapolis, IN
  • NPI 1023202470

  Dialysis facility

  Care Compare affiliation Name & address match
• Sohail Ahmed Usman, MD

  • Nephrology Physician
  • Indianapolis, IN
  • NPI 1568495513

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459382400000",
    "number": "1407052137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 CHURCH ST",
            "address_2": "SUITE 1900",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192301",
            "telephone_number": "615-777-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 S REED RD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023829",
            "telephone_number": "765-864-1669",
            "fax_number": "765-864-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY DIALYSIS - KOKOMO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2007-06-21",
        "last_updated": "2016-03-31",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "214-736-2700"
    },
    "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": "200886090A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "U.S. Renal Care Kokomo Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Larry R Lett, MD
• Kelly Ann Lewis, BS
• Meghan Lewis, RBT
• Peyton Elizabeth Lewis
• Tiffani Lewis, PTA
• Alycia Liddell, RBT
• Lifetime Dental Care of in, PC
• Josephine K Lilla, M.D.
• Lincare Inc.
• Marsha Lindley

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Kokomo, IN
• Providers in Kokomo, 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 Mar 31, 2016; 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.