NPIMap

Organization Active NPI

Sakdc - Davita Dialysis Partners LP

Doing business as Marymont Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Antonio, TX
National Provider Identifier
1598728339
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
008252 Issued in TX
Legal business name
SAKDC - DAVITA DIALYSIS PARTNERS LP
Doing business as
Marymont Dialysis Center
Practice address
2391 NE Loop 410
Ste 211
San Antonio, TX 78217-5675
Phone
(210) 646-8788
Fax
(210) 646-9324
NPI assigned
Apr 11, 2006
Last updated
Jun 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 008252 TX Primary

Addresses

Primary practice location

2391 NE Loop 410
Ste 211
San Antonio, TX 78217-5675

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
176474802MedicaidTX

Other names 1

  • Marymont Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050711000733 TX Part A Provider - End-Stage Renal Disease Facility (ESRD) 0345286365 Practice locations: San Antonio, TX

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Marymont Dialysis CenterCCN 672523
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Oct 13, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
24

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Sakdc - Davita Dialysis Partners LP17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Member of 1

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

  • Total Renal Care Inc

    dba Parkland Dialysis Center

    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Parkland, WA
    • NPI 1881987485

    Member Of

    NPD member

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1598728339",
    "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": "2391 NE LOOP 410",
            "address_2": "STE 211",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782175675",
            "telephone_number": "210-646-8788",
            "fax_number": "210-646-9324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAKDC - DAVITA DIALYSIS PARTNERS LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "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": "TX",
            "license": "008252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176474802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marymont Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marymont Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.