NPIMap

Organization Active NPI

Isd Renal Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dyersburg, TN
National Provider Identifier
1619459682
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
ISD RENAL INC
Practice address
620 Mall Blvd
Ste E
Dyersburg, TN 38024-1649
Phone
(731) 287-9448
Fax
(731) 287-9623
NPI assigned
Sep 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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 Primary

Addresses

Primary practice location

620 Mall Blvd
Ste E
Dyersburg, TN 38024-1649

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
Q049175MedicaidTN

Other names 1

  • Lewis Creek Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190529001393 TN Part A Provider - End-Stage Renal Disease Facility (ESRD) 6507053790 Practice locations: Dyersburg, TN

Other NPIs with the same Medicare PAC ID 24

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

  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Cookeville, TN
    • NPI 1003390469

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Greensboro, GA
    • NPI 1073816914

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Philadelphia, PA
    • NPI 1134640949

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Indianapolis, IN
    • NPI 1174006662

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • North Providence, RI
    • NPI 1174579619

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Pennsauken, NJ
    • NPI 1194230441

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Bridgeport, OH
    • NPI 1205396744

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Philadelphia, PA
    • NPI 1235795204

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Englewood, NJ
    • NPI 1245891670

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Philadelphia, PA
    • NPI 1295344307

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Upper Darby, PA
    • NPI 1316540388

    6507053790

    Same PAC ID
  • Isd Renal Inc
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Dayton, OH
    • NPI 1336682707

    6507053790

    Same PAC ID
View all 24

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Lewis Creek DialysisCCN 442754
Overall star rating
2.0 of 5
Ownership
Profit
Certified
May 1, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
16

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
44D2156601Isd Renal Inc620 Mall Blvd Suite E, Dyersburg, TN 38024Certificate of waiverOct 21, 2026

National Provider Directory

National Provider Directory
Tax ID family
Renal Care of Marion88 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 11

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

Member of 1

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

Locations

620 Mall Blvd
Ste E
Dyersburg, TN 38024
Phone (731) 287-9448

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1536105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1619459682",
    "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": "620 MALL BLVD",
            "address_2": "STE E",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241649",
            "telephone_number": "731-287-9448",
            "fax_number": "731-287-9623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISD RENAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-05",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q049175",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lewis Creek Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dyersburg, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.