NPIMap

Organization Active NPI

Dialysis Centers of Northwest Arkansas, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Springdale, AR
National Provider Identifier
1477027795
Registry record updated Jan 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLC
Practice address
2158 Butterfield Coach Rd
Springdale, AR 72764-9142
Phone
(479) 463-7000
NPI assigned
Jan 21, 2019
Organization subpart
Yes
Parent organization
DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2019

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

Authorized official

Name
Robert Stacy Bomstad
Title
Administrator/Ceo
Phone
(479) 463-7000

Specialties & licenses 1

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

Addresses

Primary practice location

2158 Butterfield Coach Rd
Springdale, AR 72764-9142

Mailing address

107 E Monte Painter Dr
Fayetteville, AR 72703-4002
Phone (479) 463-7000

Other names 1

  • Springdale Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190401000651 AR Part A Provider - End-Stage Renal Disease Facility (ESRD) 6800840802 Practice locations: Springdale, AR

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Dialysis Centers of Northwest Arkansas LLC2 organizations share this tax ID, including this one
Part of
Dialysis Centers of Northwest Arkansas LLC

Other organizations with this tax ID 1

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.

Locations

2158 Butterfield Coach Rd
Springdale, AR 72764
Phone (479) 463-7000

Affiliated clinicians 6

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Springdale Dialysis CtrCCN 042599
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Jul 22, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
19

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
04D2161704Springdale Dialysis Center2158 Butterfield Coach Rd, Springdale, AR 72764Certificate of waiverFeb 7, 2027

NPI Registry JSON

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

{
    "created_epoch": "1548028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548028800000",
    "number": "1477027795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E MONTE PAINTER DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034002",
            "telephone_number": "479-463-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2158 BUTTERFIELD COACH RD",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727649142",
            "telephone_number": "479-463-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLC",
        "enumeration_date": "2019-01-21",
        "last_updated": "2019-01-21",
        "status": "A",
        "authorized_official_last_name": "BOMSTAD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "STACY",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "479-463-7000"
    },
    "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": "Springdale Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springdale, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2019; 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.