Dva Healthcare Renal Care Inc

Primary specialty

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

License

170049 Issued in OR

Legal business name

DVA HEALTHCARE RENAL CARE INC

Doing business as

Roseburg Mercy Dialysis

Practice address

2410 NW Edenbower Blvd
Ste 178
Roseburg, OR 97471-8830

Phone

(541) 672-4608

Fax

(541) 672-4817

NPI assigned

Apr 4, 2006

Last updated

Sep 16, 2025By the provider in NPPES

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

• Roseburg Mercy Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Listed as

DaVita Roseburg Mercy DialysisCCN 382514

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Sep 22, 1994

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

24

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

Community Dialysis Services194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 3

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Dva Healthcare Renal Care Inc

  dba Woodburn Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Woodburn, OR
  • NPI 1467414623
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Woodburn Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Woodburn, OR
  • NPI 1487984357
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Salem Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Salem, OR
  • NPI 1992767149
  NPD tax ID

Member of 1

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

• Dva Renal Healthcare Inc

  dba Florissant Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1740241454

  Member Of

  NPD member

Locations

Affiliated clinicians 3

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

• Rubin Chandran, MD

  • Nephrology Physician
  • Hillsboro, OR
  • NPI 1972571024

  Dialysis facility

  Care Compare affiliation Name & address match
• Neil Kumar, MD

  • Nephrology Physician
  • Roseburg, OR
  • NPI 1003813015

  Dialysis facility

  Care Compare affiliation Name & address match
• Peter S McCauley, MD

  • Nephrology Physician
  • Bakersfield, CA
  • NPI 1629189113

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757980800000",
    "number": "1568424711",
    "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": "2410 NW EDENBOWER BLVD",
            "address_2": "STE 178",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718830",
            "telephone_number": "541-672-4608",
            "fax_number": "541-672-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "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": "OR",
            "license": "170049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133772",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roseburg Mercy Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Roseburg Mercy Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rodney Dean Dupper, BS
• Lloyd Ellsworth Durbin III
• Stacie Durrant
• Mical Thomas Dutson, NP
• Ingrid Marsh Duvall, MSW, LCSW
• Lucinda Jane Dykes, M.D.
• Daniel Valoes Dytz, M.D.
• Eagle Chiropractic
• Crystal Earls
• Daniel Eason, MA, QMHA

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Roseburg, OR
• Providers in Roseburg, OR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; 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.