Bridges Dialysis LLC

Primary specialty

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

Legal business name

BRIDGES DIALYSIS LLC

Practice address

3233 E Coliseum Blvd
Fort Wayne, IN 46805-1561

Phone

(260) 373-1599

Fax

(260) 373-1555

NPI assigned

Feb 27, 2012

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

• Summit City Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

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

• Bridges Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Wayne, IN
  • NPI 1003119876

  5890976450

  Same PAC ID
• Bridges Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Wayne, IN
  • NPI 1093012544

  5890976450

  Same PAC ID
• Bridges Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Wayne, IN
  • NPI 1366745630

  5890976450

  Same PAC ID

Listed as

DaVita Summit City DialysisCCN 152653

Overall star rating

3.0 of 5

Ownership

Profit

Certified

May 21, 2012

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

25

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

CLIA laboratory certificates

Tax ID family

Bridges Dialysis LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Bridges Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Wayne, IN
  • NPI 1003119876
  NPD tax ID
• Bridges Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Wayne, IN
  • NPI 1093012544
  NPD tax ID
• Bridges Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Wayne, IN
  • NPI 1366745630
  NPD tax ID

Member of 2

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

• Nephrology Associates of Northern Indiana, Inc

  • Nephrology Physician
  • Fort Wayne, IN
  • NPI 1578505814

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Castle Rock, CO
  • NPI 1386928430

  Member Of

  NPD member

Locations

Affiliated clinicians 3

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

• Prasanna Isaac, M.D.

  • Nephrology Physician
  • Fort Wayne, IN
  • NPI 1881899276

  Dialysis facility

  Care Compare affiliation Name & address match
• Maria Regina Valcarcel, MD

  • Nephrology Physician
  • Fort Wayne, IN
  • NPI 1801054358

  Dialysis facility

  Care Compare affiliation Name & address match
• Kanakapura Venkatakrishna, MD

  • Nephrology Physician
  • Fort Wayne, IN
  • NPI 1144222142

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734652800000",
    "number": "1558635276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "3233 E COLISEUM BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051561",
            "telephone_number": "260-373-1599",
            "fax_number": "260-373-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGES DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-27",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-17",
        "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": "201128730A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Summit City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Logan Bricault
• Chelsea Bridge
• Bridges Dialysis LLC
• Bridges Dialysis LLC
• Bridges Dialysis LLC
• Bridges Emotional Wellness Clinic, Inc
• Christian H Bridgwater, DO
• Kristine Briggs-Connelly, MSPT
• William F. Brigham, OD
• Bright Beginnings1

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fort Wayne, IN
• Providers in Fort Wayne, 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 Dec 20, 2024; 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.