NPIMap

Organization Active NPI

Kidney Home Center LLC

Doing business as Kidney Home Center PD

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Windsor Mill, MD
National Provider Identifier
1457500894
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E2659 Issued in MD
Legal business name
KIDNEY HOME CENTER LLC
Doing business as
Kidney Home Center PD
Practice address
2270 Rolling Run Dr Ste 600
Windsor Mill, MD 21244-1864
Phone
(410) 265-0618
Fax
(410) 265-0614
NPI assigned
Sep 10, 2008
Last updated
Aug 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Authorized official

Name
Samuel T Wey
Title
Sr Director Licensure&Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X E2659 MD Primary

Addresses

Primary practice location

2270 Rolling Run Dr Ste 600
Windsor Mill, MD 21244-1864

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4214

Other identifiers 1

IdentifierTypeStateIssuer
4186621 00MedicaidMD

Other names 1

  • KIDNEY HOME CENTER PD Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081021000150 MD Part A Provider - End-Stage Renal Disease Facility (ESRD) 4981762903 Practice locations: Windsor Mill, MD

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Kidney Home Center PDCCN 212659
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Jun 3, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
21

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
21D1097337Kidney Home Center PD2270 Rolling Run Drive Ste 600, Baltimore, MD 21244Certificate of waiverMar 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Glen Burnie Home Training3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 2

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

  • Total Renal Care Inc

    dba Rose Point Dialysis

    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Wasco, CA
    • NPI 1871007617

    Member Of

    NPD member
  • Total Renal Care Inc

    dba Parkland Dialysis Center

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

    Member Of

    NPD member

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1457500894",
    "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",
            "telephone_number": "615-320-4214",
            "fax_number": "888-944-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2270 ROLLING RUN DR STE 600",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212441864",
            "telephone_number": "410-265-0618",
            "fax_number": "410-265-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY HOME CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-10",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR DIRECTOR LICENSURE&CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MD",
            "license": "E2659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4186621 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIDNEY HOME CENTER PD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Windsor Mill, MD

Sources for this page

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

Verify at the official NPI Registry.