NPIMap

Organization Active NPI

Physicians Dialysis of Lancaster LLC

Doing business as PDI Lancaster

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Lancaster, PA
National Provider Identifier
1629030432
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
PHYSICIANS DIALYSIS OF LANCASTER LLC
Doing business as
PDI Lancaster
Practice address
1412 E King St
Lancaster, PA 17602-3240
Phone
(717) 392-1552
Fax
(717) 392-4413
NPI assigned
Apr 5, 2006
Last updated
Feb 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 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 L & C Department
Phone
(615) 341-6641

Specialties & licenses 1

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

Addresses

Primary practice location

1412 E King St
Lancaster, PA 17602-3240

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
100737549 0008MedicaidPA

Other names 1

  • PDI Lancaster Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030519000002 PA Part A Provider - End-Stage Renal Disease Facility (ESRD) 5193634608 Practice locations: Lancaster, PA

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Pdi LancasterCCN 392609
Overall star rating
5.0 of 5
Ownership
Profit
Certified
Jul 23, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
17

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
39D0929445Pdi-Lancaster LLC1412 East King Street, Lancaster, PA 17602Certificate of waiverSep 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Physicians Dialysis of Lancaster LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

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": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740009600000",
    "number": "1629030432",
    "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": "1412 E KING ST",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176023240",
            "telephone_number": "717-392-1552",
            "fax_number": "717-392-4413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS DIALYSIS OF LANCASTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP L & C DEPARTMENT",
        "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": "100737549 0008",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDI Lancaster",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PDI Lancaster",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lancaster, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.