Active NPI
Brook Dialysis LLC
Doing business as Charles County Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- White Plains, MD
National Provider Identifier
1487922365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- E2672
- Legal business name
- BROOK DIALYSIS LLC
- Doing business as
- Charles County Dialysis
- Practice address
- 4475 Regency PL
Ste 102&103
White Plains, MD 20695-3072 - Phone
- (301) 932-9874
- Fax
- (301) 638-2846
- NPI assigned
- Dec 7, 2011
- Last updated
- Dec 1, 2025
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | E2672 | MD | Primary |
Addresses
Primary practice location
4475 Regency PL
Ste 102&103
White Plains, MD 20695-3072
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4213483 00 | Medicaid | MD |
Other names 1
- Charles County Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120419000178 | MD | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 0345401352 | Practice locations: White Plains, MD |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Brandywine Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Brandywine, MD
- NPI 1861899049
0345401352
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita Charles County Dialysis
- Overall star rating
- Ownership
- Profit
- Certified
- Jul 23, 2012
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 17
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 NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D2042102 | Charles County Dialysis | Certificate of waiver | Jun 5, 2028 |
National Provider Directory
National Provider Directory- Tax ID family
- Brandywine Dialysis
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Brandywine Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Brandywine, MD
- NPI 1861899049
-
dba Virginia Hospital Center Physician Group - Endocrinology
- Endocrinology, Diabetes & Metabolism Physician
- Arlington, VA
- NPI 1528475118
Member of 3
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Kenwood Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Chicago, IL
- NPI 1831896364
Member Of
-
dba Bountiful Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Bountiful, UT
- NPI 1184387516
Member Of
-
dba Keys Gate Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Homestead, FL
- NPI 1578992558
Member Of
Practitioners & affiliated clinicians
Affiliated clinicians 4
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": "1323216000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1764547200000",
"number": "1487922365",
"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": "4475 REGENCY PL",
"address_2": "STE 102&103",
"city": "WHITE PLAINS",
"state": "MD",
"postal_code": "206953072",
"telephone_number": "301-932-9874",
"fax_number": "301-638-2846"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROOK DIALYSIS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2011-12-07",
"last_updated": "2025-12-01",
"certification_date": "2025-12-01",
"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": "MD",
"license": "E2672",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4213483 00",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Charles County Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Charles County Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in White Plains, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.