NPIMap

Organization Active NPI

Etowah Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bethlehem, PA
National Provider Identifier
1457787715
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
ETOWAH DIALYSIS LLC
Practice address
1425 8TH Ave
Bethlehem, PA 18018-2256
Phone
(484) 403-4304
Fax
(610) 866-1739
NPI assigned
Sep 18, 2013
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Samuel Wey
Title
VP, Licensure & Certification
Phone
(615) 341-6641

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 6

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

Member of 1

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

Affiliated clinicians 4

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita St Luke's Bethlehem DialysisCCN 392817
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Sep 1, 2013
Medicare certification status
Active (Provider of Services file)
Chain
DaVita
Dialysis stations
36

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
39D2071826St Lukes Bethlehem Dialysis1425 8TH Ave, Bethlehem, PA 18018Certificate of waiverJan 20, 2028

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20140328001606 PA Part a Provider - End-Stage Renal Disease Facility (ESRD) 2567699085 Practice locations: Bethlehem, PA

National Provider Directory

National Provider Directory
Tax ID family
Etowah Dialysis LLC (7 organizations share this tax ID)

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

1425 8TH Ave
Bethlehem, PA 18018-2256

Mailing address

5200 Virginia Way
L & C Dept
Brentwood, TN 37027-7569
Phone (615) 341-6410

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
1029243170002MedicaidPA

Other names 1

NPPES NPI Registry
  • St Lukes Bethlehem Dialysis Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 10, 2023.

{
    "created_epoch": "1379462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699574400000",
    "number": "1457787715",
    "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": "615-341-6410",
            "fax_number": "888-662-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 8TH AVE",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180182256",
            "telephone_number": "484-403-4304",
            "fax_number": "610-866-1739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETOWAH DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-18",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029243170002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Lukes Bethlehem Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Lukes Bethlehem Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethlehem, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.