NPIMap

Organization Active NPI

Dialysis Clinic Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Mount Vernon, KY
National Provider Identifier
1407324247
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DIALYSIS CLINIC INC
Practice address
145 Newcomb Ave
Mount Vernon, KY 40456-2728
Phone
(606) 392-4102
Fax
(606) 392-4103
NPI assigned
Nov 9, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

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

Authorized official

Name
William E. Wood II
Title
President
Phone
(615) 327-3061

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

145 Newcomb Ave
Mount Vernon, KY 40456-2728

Mailing address

100 Venture CT
Lexington, KY 40511-2600
Phone (859) 252-7712

Other names 1

  • DCI Rockcastle Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181227000055 KY Part A Provider - End-Stage Renal Disease Facility (ESRD) 4284541129 Practice locations: Mount Vernon, KY

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Dialysis Clinic IncCCN 182643
Overall star rating
2.0 of 5
Ownership
Non-profit
Certified
Apr 3, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Dialysis Clinic, Inc.
Dialysis stations
12

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 NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2164114Dialysis Clinic, Inc - Rockcastle145 Newcomb Avenue, Mount Vernon, KY 40456Certificate of waiverMar 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Elbert P Tuttle Jr MD238 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 9

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rancho Dialysis ClinicSacramento, CA, CCN 552519 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 24, 2003
Dec 24, 2003

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1541721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1407324247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 VENTURE CT",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405112600",
            "telephone_number": "859-252-7712",
            "fax_number": "859-252-2117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 NEWCOMB AVE",
            "city": "MOUNT VERNON",
            "state": "KY",
            "postal_code": "404562728",
            "telephone_number": "606-392-4102",
            "fax_number": "606-392-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-09",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-327-3061",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DCI Rockcastle",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DCI Rockcastle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, KY

Sources for this page

Verify at the official NPI Registry.