Mocca Dialysis LLC

Primary specialty

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

Legal business name

MOCCA DIALYSIS LLC

Doing business as

Spring Street Dialysis

Practice address

1601 Spring St
Jeffersonville, IN 47130-2903

Phone

(812) 284-2098

Fax

(812) 284-2680

NPI assigned

Feb 20, 2014

Organization subpart

No

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

Authorized official

Name

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Spring Street Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Member of 1

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

• Total Renal Care Inc

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

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1392854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1538584032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 SPRING ST",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471302903",
            "telephone_number": "812-284-2098",
            "fax_number": "812-284-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOCCA DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-20",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201270660 A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spring Street Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spring Street Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Roxie Dimple Miner, LCSW
• Susan Minton, MSSW
• Grace Missi, MA-CCC-SLP
• Ryan M Missi, APRN-BC
• MLB Jeffersonville Health Facilities, Inc
• Gillian Moffitt, RBT
• Brianna Montgomery, RBT
• Miranda Montgomery, RBT
• Oliver S Montoya, MD
• Courtney Moon, RBT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.