NPIMap

Organization Active NPI

Renal Treatment Centers - Mid-Atlantic Inc

Doing business as Heritage Lake Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Gettysburg, PA
National Provider Identifier
1467966127
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
RENAL TREATMENT CENTERS - MID-ATLANTIC INC
Doing business as
Heritage Lake Dialysis
Practice address
20 Expedition TRL
Ste 202
Gettysburg, PA 17325-8599
Phone
(717) 337-1012
Fax
(717) 337-3834
NPI assigned
Nov 16, 2017
Last updated
Sep 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Authorized official

Name
Samuel 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 NU Primary

Addresses

Primary practice location

20 Expedition TRL
Ste 202
Gettysburg, PA 17325-8599

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
103444602MedicaidPA

Other names 1

  • Heritage Lake Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180112001475 PA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4587572383 Practice locations: Gettysburg, PA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Heritage Lake DialysisCCN 392869
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Apr 4, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
9

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
39D2144847Heritage Lake Dialysis20 Expedition TRL, Ste 202, Gettysburg, PA 17325Certificate of waiverFeb 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Renal Treatment Centers - Mid-Atlantic Inc80 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1510790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694390400000",
    "number": "1467966127",
    "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": "20 EXPEDITION TRL",
            "address_2": "STE 202",
            "city": "GETTYSBURG",
            "state": "PA",
            "postal_code": "173258599",
            "telephone_number": "717-337-1012",
            "fax_number": "717-337-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS - MID-ATLANTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-16",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103444602",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Lake Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gettysburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.