Active NPI
Garrett Dialysis LLC
Doing business as Ridge Park Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Cleveland, OH
National Provider Identifier
1407256092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- 1118DC
- Legal business name
- GARRETT DIALYSIS LLC
- Doing business as
- Ridge Park Dialysis
- Practice address
- 4805 Pearl Rd
Cleveland, OH 44109-5145 - Phone
- (216) 398-6029
- Fax
- (216) 398-6053
- NPI assigned
- Sep 2, 2014
- Last updated
- May 30, 2023
- 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
- John D Winstel
- Title
- Chief Accounting Officer
- Phone
- (253) 733-4501
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 1118DC | OH | Primary |
Addresses
Primary practice location
4805 Pearl Rd
Cleveland, OH 44109-5145
Mailing address
5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569
Phone (615) 238-3051
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0141166 | Medicaid | OH |
Other names 1
- Ridge Park Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141020002557 | OH | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 4082852983 | Practice locations: Cleveland, OH |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Kidney Center of Brunswick
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Brunswick, OH
- NPI 1598006959
4082852983
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita Ridge Park Dialysis
- Overall star rating
- Ownership
- Profit
- Certified
- Jul 1, 2015
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 13
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 |
|---|---|---|---|
| 36D2084901 | Ridge Park Dialysis | Certificate of waiver | Oct 2, 2026 |
National Provider Directory
National Provider Directory- Tax ID family
- Davita Kidney Center of Brunswick
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Shoreline Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Fairview Park, OH
- NPI 1508266289
-
dba Kidney Center of Brunswick
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Brunswick, OH
- NPI 1598006959
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Cerritos Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Cerritos, CA
- NPI 1255681011
Member Of
Locations
4805 Pearl Rd
Cleveland, OH 44109
Phone (216) 398-6029
Practitioners & affiliated clinicians
Affiliated clinicians 4
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": "1409616000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1685404800000",
"number": "1407256092",
"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",
"telephone_number": "615-238-3051",
"fax_number": "800-246-8346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 PEARL RD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441095145",
"telephone_number": "216-398-6029",
"fax_number": "216-398-6053"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GARRETT DIALYSIS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-09-02",
"last_updated": "2023-05-30",
"certification_date": "2023-05-18",
"status": "A",
"authorized_official_last_name": "WINSTEL",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
"authorized_official_telephone_number": "253-733-4501"
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "OH",
"license": "1118DC",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0141166",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Ridge Park Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Ridge Park Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; 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.