Myrtle Dialysis LLC

Primary specialty

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

Legal business name

MYRTLE DIALYSIS LLC

Practice address

421 Stageline Rd
Hudson, WI 54016-7848

Phone

(715) 381-8240

Fax

(715) 381-8454

NPI assigned

Feb 25, 2015

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

• Hudson Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Listed as

DaVita Hudson DialysisCCN 522606

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Apr 8, 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 3

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

• Hudson Hospital, Inc.

  • Critical Access Hospital
  • Hudson, WI
  • NPI 1255532875

  Member Of

  NPD member
• Group Health Plan Inc

  • Durable Medical Equipment & Medical Supplies
  • Roseville, MN
  • NPI 1821159732

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Locations

Affiliated clinicians 4

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

• Maryyam Ali, M.D.

  • Nephrology Physician
  • Maplewood, MN
  • NPI 1518386093

  Dialysis facility

  Care Compare affiliation Name & address match
• Salvador Federico Calaf, M.D.

  • Orthopaedic Surgery Physician
  • Saint Paul, MN
  • NPI 1053572156

  Dialysis facility

  Care Compare affiliation Name & address match
• Randa Dincer, M.D.

  • Nephrology Physician
  • Saint Paul, MN
  • NPI 1144428285

  Dialysis facility

  Care Compare affiliation Name & address match
• Raymond John Poor, M.D.

  • Nephrology Physician
  • Roseville, MN
  • NPI 1730106576

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1424822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746489600000",
    "number": "1487046652",
    "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": "421 STAGELINE RD",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167848",
            "telephone_number": "715-381-8240",
            "fax_number": "715-381-8454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTLE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-25",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "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": "Hudson Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hudson Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Move.Well, LLC
• Taylor Ann Mueller, DNP, FNP
• Rochelle Lynn Murphy Rymer, MA
• Colette E Murphy, CCC/SLP
• John Thomas Murphy, MD
• Jessica Rachelle Nadeau, MFT
• Michelle Mary Nadrchal, MD
• Peter Anthony Nasseff, PHD
• Natural Medicine Center of Wisconsin LLC
• Deanna R Ndebele, APSW

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Hudson, WI
• Providers in Hudson, 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 May 6, 2025; 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.