Dialysis Clinic Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Belfast, ME
NPI 1497788970 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1497788970
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 37201 (ME)
- Legal business name
- DIALYSIS CLINIC INC.
- Practice address
- 125 Northport Ave
Belfast, ME 04915-6002 - Phone
- (207) 338-1170
- Fax
- (207) 338-4472
- NPI assigned
- Jul 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Donovan Schultz
- Title
- President
- Phone
- (615) 327-3061
Corporate family (same tax ID) 2
Affiliated clinicians 1
-
Mauricio Botero-Velez, M.D.
Medicare Care Compare: Dialysis facility
- Listed as
- Dialysis Clinic Inc. - Belfast
- Overall star rating
- ★★★☆☆ 3.0 of 5
- Ownership
- Non-profit
- Certified
- Feb 3, 2006
- Medicare certification status
- Active
- Chain
- Dialysis Clinic, Inc.
- Dialysis stations
- 12
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Rancho Dialysis Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Dec 24, 2003 Dec 24, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051229000032 | ME | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Belfast, ME |
National Provider Directory
- Tax ID family
- Elbert P Tuttle Jr MD
Locations
125 Northport Ave
#101
Belfast, ME 04915
Phone (207) 338-1170
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 37201 | ME | Yes |
Addresses
Primary practice location
125 Northport Ave
Belfast, ME 04915-6002
Mailing address
125 Northport Ave
Belfast, ME 04915-6002
Phone (207) 338-1170
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004201430 | Medicaid | CT | |
| 185220001 | Medicaid | ME |
Other providers in Belfast, ME
- Matthew Decoteau
- Sarah Delaney
- James C Delehanty
- Kyle Dennis
- Matthew Desjardins
- Dirigo Consulting
- Dr Kerri Vacher LLC
- Dr. Michael Wright, LCSW
- DRS. Dutch & Marnecheck,LLC
- Morgan Amber Dube
All providers in Belfast, ME · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.