NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Aiken, SC
National Provider Identifier
1477515575
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ERD-0034 Issued in SC
Legal business name
DVA HEALTHCARE RENAL CARE INC
Practice address
775 Medical Park Dr
Aiken, SC 29801-6306
Phone
(803) 641-4222
Fax
(803) 641-4224
NPI assigned
Apr 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X ERD-0034 SC Primary

Addresses

Primary practice location

775 Medical Park Dr
Aiken, SC 29801-6306

Mailing address

5200 Virginia Way
L&C Department
Brentwood, TN 37027-7569
Phone (615) 320-4593

Other identifiers 2

IdentifierTypeStateIssuer
000855709KMedicaidGA
425123MedicaidSC

Other names 1

  • Aiken Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030527000015 SC Part A Provider - End-Stage Renal Disease Facility (ESRD) 7517875545 Practice locations: Aiken, SC

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Aiken DialysisCCN 422512
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Jul 7, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
22

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
42D0658826Aiken Dialysis775 Medical Park Drive, Aiken, SC 29801Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
CDS of Zephyrhills194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 8

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

Member of 1

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

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": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1477515575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4593",
            "fax_number": "800-293-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 MEDICAL PARK DR",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298016306",
            "telephone_number": "803-641-4222",
            "fax_number": "803-641-4224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "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",
        "authorized_official_credential": "AO"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "SC",
            "license": "ERD-0034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000855709K",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425123",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aiken Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Aiken Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aiken, SC

Sources for this page

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