Fanthorp Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

FANTHORP DIALYSIS LLC

Doing business as

Dialysis at Mankato Clinic

Practice address

1400 Madison Ave Ste 400
Mankato, MN 56001-5476

Phone

(507) 385-0432

Fax

(507) 385-1584

NPI assigned

Jul 23, 2012

Organization subpart

No

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

Authorized official

Name

John Winstel

Title

Chief Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other names 1

• Dialysis at Mankato Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Listed as

DaVita Dialysis at Mankato ClinicCCN 242585

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Feb 27, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

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

• Mankato Clinic LTD

  • Family Medicine Physician
  • Mankato, MN
  • NPI 1629044029

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Locations

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Karl Philip Roos, MD

  • Nephrology Physician
  • Mankato, MN
  • NPI 1518004803

  Dialysis facility

  Care Compare affiliation Name & address match
• Charat Thongprayoon, M.D.

  • Nephrology Physician
  • Rochester, MN
  • NPI 1659765188

  Dialysis facility

  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1538414941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4514",
            "fax_number": "866-594-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MADISON AVE STE 400",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015476",
            "telephone_number": "507-385-0432",
            "fax_number": "507-385-1584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANTHORP DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-23",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dialysis at Mankato Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dialysis at Mankato Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor Shae Fairchild
• Abby Falgren
• Family Decisions LLC
• Daniel Fandrich
• Patricia Fandrich
• Abdirahman Mohamud Farah
• Ladan Farah
• Katelin Michelle Farmer, LICSW, MSW, LGSW
• Michael Gordon Farnsworth, MD
• Whitney Farr

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Mankato, MN
• Providers in Mankato, MN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Minnesota

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