NPIMap

Dialysis Clinic Inc

Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Hermitage, TN

NPI 1609337161 · NPPES record last updated Oct 4, 2023

Key facts

NPI
1609337161
Entity type
Organization (NPI type 2)
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
Legal business name
DIALYSIS CLINIC INC
Practice address
5653 Frist Blvd Ste 334
Hermitage, TN 37076-2064
Phone
(615) 902-7036
Fax
(615) 391-8528
NPI assigned
Mar 27, 2019
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

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

Affiliated clinicians 1

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

Medicare Care Compare: Dialysis facility

Listed as
DCI Hermitage CCN 442763
Overall star rating
★★☆☆☆ 2.0 of 5
Ownership
Non-profit
Certified
Jan 13, 2020
Medicare certification status
Active (Provider of Services file)
Chain
Dialysis Clinic, Inc.
Dialysis stations
10

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2175244Dialysis Clinic, Inc Hermitage
5653 Frist Boulevard, Hermitage, TN 37076		Certificate of waiverNov 18, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TN

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 Clinic
Sacramento, CA · CCN 552519		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 24, 2003
Dec 24, 2003

Medicare enrollment records

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

National Provider Directory

Tax ID family
Elbert P Tuttle Jr MD (238 organizations share this tax ID)

Specialties & licenses

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

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

  • Dialysis Clinic Inc (Hermitage) Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 4, 2023.

{
    "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

All providers in Hermitage, TN · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Tennessee

Sources for this page

Verify at the official NPI Registry.