NPIMap

Organization Active NPI

Advanced Dialysis Center, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
National Provider Identifier
1508029372
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E2656 Issued in MD
Legal business name
ADVANCED DIALYSIS CENTER, LLC
Practice address
299 Hurley Ave
Rockville, MD 20850-3118
Phone
(301) 577-1007
Fax
(301) 577-1006
NPI assigned
Jul 2, 2008
Organization subpart
Yes
Parent organization
ADVANCED DIALYSIS CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Authorized official

Name
Mary Hayes Jenkins, RN
Title
Ceo
Phone
(202) 422-7492

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X E2656 MD Primary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X

Addresses

Primary practice location

299 Hurley Ave
Rockville, MD 20850-3118

Mailing address

9320 Annapolis Rd
Suite 200
Lanham, MD 20706-3100
Phone (301) 577-1007

Other identifiers 1

IdentifierTypeStateIssuer
406877700MedicaidMD

Other names 1

  • Advanced Dialysis Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Lanham Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080821000298 MD Part A Provider - End-Stage Renal Disease Facility (ESRD) 9032188131 Practice locations: Rockville, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Advanced Dialysis Center - RockvilleCCN 212656
Ownership
Profit
Certified
Oct 7, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
9

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
21D2004976Advanced Dialysis Center Collingswood299 Hurley Avenue, Rockville, MD 20850Certificate of waiverApr 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Advanced Dialysis Center3 organizations share this tax ID, including this one
Part of
Advanced Dialysis Center

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 5

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": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1508029372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9320 ANNAPOLIS RD",
            "address_2": "SUITE 200",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063100",
            "telephone_number": "301-577-1007",
            "fax_number": "301-577-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 HURLEY AVE",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503118",
            "telephone_number": "301-577-1007",
            "fax_number": "301-577-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DIALYSIS CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED DIALYSIS CENTER, LLC",
        "enumeration_date": "2008-07-02",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "HAYES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "202-422-7492",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MD",
            "license": "E2656",
            "primary": true
        },
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "406877700",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Lanham",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "299 Hurley Ave",
            "city": "Rockville",
            "state": "MD",
            "country_code": "US",
            "postal_code": "208503118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Advanced Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; 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.