NPIMap

Organization Active NPI

Whitney Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Oxon Hill, MD
National Provider Identifier
1497029664
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
WHITNEY DIALYSIS LLC
Practice address
5442 Saint Barnabas Rd
Oxon Hill, MD 20745-3622
Phone
(301) 894-0572
Fax
(301) 630-1389
NPI assigned
Mar 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Addresses

Primary practice location

5442 Saint Barnabas Rd
Oxon Hill, MD 20745-3622

Mailing address

5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
421511700MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120622000406 MD Part A Provider - End-Stage Renal Disease Facility (ESRD) 6305001447 Practice locations: Oxon Hill, MD

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita PG County South DialysisCCN 212675
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Oct 24, 2012
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.

National Provider Directory

National Provider Directory

Member of 3

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

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1330905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1497029664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "5442 SAINT BARNABAS RD",
            "city": "OXON HILL",
            "state": "MD",
            "postal_code": "207453622",
            "telephone_number": "301-894-0572",
            "fax_number": "301-630-1389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITNEY DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-05",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "421511700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oxon Hill, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.