NPIMap

Organization Active NPI

Physicians Dialysis Acquisitions Inc

Doing business as PDI Grand Rapids East

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Grand Rapids, MI
National Provider Identifier
1568424455
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
PHYSICIANS DIALYSIS ACQUISITIONS INC
Doing business as
PDI Grand Rapids East
Practice address
1230 Ekhart St NE
Grand Rapids, MI 49503-1372
Phone
(616) 742-8930
Fax
(616) 742-0456
NPI assigned
Apr 5, 2006
Last updated
Sep 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Authorized official

Name
Samuel T Wey
Title
Sr Director Licensure&Certification
Phone
(615) 341-6641

Specialties & licenses 1

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

Addresses

Primary practice location

1230 Ekhart St NE
Grand Rapids, MI 49503-1372

Mailing address

5200 Virginia Way
Att: L&C Department
Brentwood, TN 37027-7569
Phone (615) 320-4514

Other identifiers 1

IdentifierTypeStateIssuer
1568424455MedicaidMI

Other names 1

  • PDI Grand Rapids East Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20021216000001 MI Part A Provider - End-Stage Renal Disease Facility (ESRD) 2769399666 Practice locations: Grand Rapids, MI

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Physicians Dialysis Acquisitions Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1568424455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPARTMENT",
            "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": "1230 EKHART ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031372",
            "telephone_number": "616-742-8930",
            "fax_number": "616-742-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS DIALYSIS ACQUISITIONS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-22",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR DIRECTOR 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": "1568424455",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDI Grand Rapids East",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PDI Grand Rapids East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; 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.