Montauk Dialysis LLC

Primary specialty

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

Legal business name

MONTAUK DIALYSIS LLC

Doing business as

Sun Prairie Dialysis

Practice address

719 Bunny Trail
Sun Prairie, WI 53590-0000

Phone

(608) 825-6556

Fax

(608) 825-2886

NPI assigned

Apr 7, 2015

Last updated

Jun 25, 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 T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other names 1

• Sun Prairie Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Listed as

DaVita Sun Prairie DialysisCCN 522607

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Aug 11, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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

CLIA laboratory certificates

Member of 1

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

• Total Renal Care, Inc.

  dba Bountiful Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bountiful, UT
  • NPI 1184387516

  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, and the practitioner matching its NPPES authorized official.

• David W Koeper, MD

  • Nephrology Physician
  • Neenah, WI
  • NPI 1487698387
  NPD (past)

Affiliated clinicians 1

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

• Atif A Qureshi, MD

  • Nephrology Physician
  • Neenah, WI
  • NPI 1629014790

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719273600000",
    "number": "1457747453",
    "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": "719 BUNNY TRAIL",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535900000",
            "telephone_number": "608-825-6556",
            "fax_number": "608-825-2886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTAUK DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sun Prairie Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sun Prairie Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara Elizabeth Moen
• Adebowale Mofikoya, M.D.
• Blair David Moldenhauer, DMD
• Molly Sanders Therapy, LLC
• Monica Patrick Orthodontics
• Kyle Thomas Moore, DC
• Carol Jan Morris, FNP-C
• Rosa Morrow, LMFT
• Gregory H Motl, MD
• Lauren A Murphy, AA-C

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Sun Prairie, WI
• Providers in Sun Prairie, WI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.