Dva Renal Healthcare Inc

Primary specialty

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

Legal business name

DVA RENAL HEALTHCARE INC

Doing business as

Grand Central Dialysis

Practice address

800 Grand Central Mall
Ste 8
Vienna, WV 26105-4100

Phone

(304) 917-4124

Fax

(304) 917-4136

NPI assigned

Apr 18, 2006

Last updated

May 15, 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 Wey

Title

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Grand Central Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Listed as

DaVita Grand Central DialysisCCN 512519

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Dec 1, 2000

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

18

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

CLIA laboratory certificates

Tax ID family

Gambro Healthcare Escon173 organizations share this tax ID, including this one

Affiliated clinicians 4

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

• Mirza T Hamirani, M.D.

  • Nephrology Physician
  • Vienna, WV
  • NPI 1861460099

  Dialysis facility

  Care Compare affiliation Name & address match
• Neeharika Muddana, M.D.

  • Nephrology Physician
  • Parkersburg, WV
  • NPI 1649448911

  Dialysis facility

  Care Compare affiliation Name & address match
• Siddharth Verma, M.D.

  • Nephrology Physician
  • Parkersburg, WV
  • NPI 1336502798

  Dialysis facility

  Care Compare affiliation Name & address match
• Mahyar Tahbaz, DO

  • Nephrology Physician
  • Marietta, OH
  • NPI 1770583031

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1457316085",
    "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": "800 GRAND CENTRAL MALL",
            "address_2": "STE 8",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261054100",
            "telephone_number": "304-917-4124",
            "fax_number": "304-917-4136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0402016000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2330025",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Central Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Central Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Duckworth
• Alena Lola Dulaney
• Alicia Duranti, RN
• Dustin Huffman, DDS, and Angel Cook-Huffman, DDS, Inc (Vienna Dental Associates)
• Mary Anne Dutton
• Nathaniel Ealy III
• William Jeffrey Earley, DO
• Echard Drug Co. Inc. (Echard Drug Co.)
• Tara Edwards
• Rebecca Diane Eichhorn

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Vienna, WV
• Providers in Vienna, WV by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.