NPIMap

Organization Active NPI

University Hospital of Brooklyn Suny Downstate Health Sciences Univers

Doing business as SUNY Parkside Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1528027414
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
7001037H Issued in NY
Legal business name
UNIVERSITY HOSPITAL OF BROOKLYN SUNY DOWNSTATE HEALTH SCIENCES UNIVERS
Doing business as
SUNY Parkside Dialysis Center
University Hospital of Brooklyn
Practice address
710 Parkside Ave
Brooklyn, NY 11203-1507
Phone
(718) 826-4931
Fax
(718) 826-5045
NPI assigned
Mar 21, 2006
Last updated
Aug 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Authorized official

Name
Mr. Sean P Smith, CPA
Title
Sr Associate VP/Deputy Cfo
Phone
(718) 826-4943

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 7001037H NY Primary

Addresses

Primary practice location

710 Parkside Ave
Brooklyn, NY 11203-1507

Mailing address

710 Parkside Ave
Brooklyn, NY 11203-1507
Phone (718) 826-4931

Other names 2

  • SUNY Parkside Dialysis Center Doing business as
  • University Hospital of Brooklyn Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220811003607 NY Part A Provider - End-Stage Renal Disease Facility (ESRD) 7113318122 Practice locations: Brooklyn, NY

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Suny Parkside Dialysis CenterCCN 333544
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Dec 22, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
24

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
33D0991069Suny Downstate Medical Center Parkside Dialysis710 Parkside Avene, Brooklyn, NY 11203Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
University Hospital of Brooklyn Suny Downstate Health Sciences Unive5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member of 1

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

Locations

284 Baltic St
Brooklyn, NY 11201
Phone (718) 330-9390

470 Clarkson Ave
Brooklyn, NY 11203
Phone (718) 826-4900

557 Pennsylvania Ave
Brooklyn, NY 11207
Phone (718) 498-3717

699 92nd St
Brooklyn, NY 11228
Phone (718) 259-7300

Practitioners & affiliated clinicians

Practitioners 167

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 167

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": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1528027414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 PARKSIDE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031507",
            "telephone_number": "718-826-4931",
            "fax_number": "718-826-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 PARKSIDE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031507",
            "telephone_number": "718-826-4931",
            "fax_number": "718-826-5045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY HOSPITAL OF BROOKLYN SUNY DOWNSTATE HEALTH SCIENCES UNIVERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SR ASSOCIATE VP/DEPUTY CFO",
        "authorized_official_telephone_number": "718-826-4943",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "7001037H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUNY Parkside Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University Hospital of Brooklyn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; 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.