NPIMap

Organization Active NPI

Renal Treatment Centers-Southeast, LP.

Doing business as Perry County Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Marion, AL
National Provider Identifier
1609127273
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
S5301
Legal business name
RENAL TREATMENT CENTERS-SOUTHEAST, LP.
Doing business as
Perry County Dialysis
Practice address
611 E Lafayette St
Marion, AL 36756-2325
Phone
(334) 683-8519
Fax
(334) 683-4777
NPI assigned
Sep 24, 2012
Last updated
Dec 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Authorized official

Name
John D. Winstel
Title
Chief Accounting Officer
Phone
(253) 733-4501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X S5301 Primary

Addresses

Primary practice location

611 E Lafayette St
Marion, AL 36756-2325

Mailing address

5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4268

Other identifiers 1

IdentifierTypeStateIssuer
149097MedicaidAL

Other names 1

  • Perry County Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160122002254 AL Part A Provider - End-Stage Renal Disease Facility (ESRD) 1658555255 Practice locations: Marion, AL

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Perry County DialysisCCN 012663
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Mar 27, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
10

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2051739Perry County Dialysis611 Lafayette St, Marion, AL 36756Certificate of waiverDec 26, 2026

National Provider Directory

National Provider Directory
Tax ID family
Bradley County Dialysis138 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

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

View all 22

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1348444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1609127273",
    "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",
            "telephone_number": "615-320-4268",
            "fax_number": "877-238-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E LAFAYETTE ST",
            "city": "MARION",
            "state": "AL",
            "postal_code": "367562325",
            "telephone_number": "334-683-8519",
            "fax_number": "334-683-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-SOUTHEAST, LP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-24",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-13",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": "S5301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149097",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perry County Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Perry County Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; 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.