Dialysis Clinic Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Shelbyville, TN
NPI 1528091907 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1528091907
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 0000000031 (TN)
- Legal business name
- DIALYSIS CLINIC INC.
- Practice address
- 120 Frank Martin Rd Ste 202
Shelbyville, TN 37160-7195 - Phone
- (931) 684-3040
- Fax
- (931) 684-3767
- 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) 24
Affiliated clinicians 3
-
Ralph C. Atkinson III, M.D.
-
Oladapo O Omitowoju, M.D.
Medicare Care Compare: Dialysis facility
- Listed as
- Dci Shelbyville
- Overall star rating
- ★★★☆☆ 3.0 of 5
- Ownership
- Non-profit
- Certified
- Jul 8, 1994
- Medicare certification status
- Active
- Chain
- Dialysis Clinic, Inc.
- Dialysis stations
- 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0936646 | Dialysis Clinic Inc | Certificate of waiver | Nov 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
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 |
|---|---|---|---|---|
| O20040507000183 | TN | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Shelbyville, TN |
National Provider Directory
- Tax ID family
- Elbert P Tuttle Jr MD
Locations
120 Frank Martin Rd
Ste 202
Shelbyville, TN 37160
Phone (931) 393-4995
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 0000000031 | TN | Yes |
Addresses
Primary practice location
120 Frank Martin Rd Ste 202
Shelbyville, TN 37160-7195
Mailing address
120 Frank Martin Rd Ste 202
Shelbyville, TN 37160-7195
Phone (931) 684-3040
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0442586 | Medicaid | TX | |
| 0442586 | Medicaid | TN |
Other providers in Shelbyville, TN
- Amber Dawson
- Alexis Y De la Paz-Tavera
- Mindy Deal
- John Robert Deharde
- Kiwana N Derrick
- Digestive Healthcare of Central Tennessee, PLLC
- Charles W Dinwiddie
- John Mason Douglas
- Lauren Watts Drukenbrod
- Rebecca Louise Dunn
All providers in Shelbyville, TN · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Tennessee
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.