NPIMap

Organization Active NPI

Dialysis Clinic Inc

Doing business as Dialysis Clinic Inc (Hermitage)

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hermitage, TN
National Provider Identifier
1609337161
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DIALYSIS CLINIC INC
Doing business as
Dialysis Clinic Inc (Hermitage)
Practice address
5653 Frist Blvd Ste 334
Hermitage, TN 37076-2064
Phone
(615) 902-7036
Fax
(615) 391-8528
NPI assigned
Mar 27, 2019
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Donovan Schultz
Title
President
Phone
(615) 327-3061

Specialties & licenses 1

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

Addresses

Primary practice location

5653 Frist Blvd Ste 334
Hermitage, TN 37076-2064

Mailing address

1617 Williams Dr Ste 100
Murfreesboro, TN 37129-3286
Phone (615) 890-7741

Other names 1

  • Dialysis Clinic Inc (Hermitage) Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190508001575 TN Part A Provider - End-Stage Renal Disease Facility (ESRD) 4284541129 Practice locations: Hermitage, TN

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DCI HermitageCCN 442763
Overall star rating
2.0 of 5
Ownership
Non-profit
Certified
Jan 13, 2020
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Dialysis Clinic, Inc.
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
44D2175244Dialysis Clinic, Inc Hermitage5653 Frist Boulevard, Hermitage, TN 37076Certificate of waiverNov 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Margaret Dillard MD238 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rancho Dialysis ClinicSacramento, CA, CCN 552519 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 24, 2003
Dec 24, 2003

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": "1553644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1609337161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 WILLIAMS DR STE 100",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371293286",
            "telephone_number": "615-890-7741",
            "fax_number": "615-848-0570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5653 FRIST BLVD STE 334",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370762064",
            "telephone_number": "615-902-7036",
            "fax_number": "615-391-8528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-27",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DONOVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-327-3061"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dialysis Clinic Inc (Hermitage)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dialysis Clinic Inc (Hermitage)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hermitage, TN

Sources for this page

Verify at the official NPI Registry.