Active NPI
Dva Renal Healthcare Inc
Doing business as Newaygo County Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Fremont, MI
National Provider Identifier
1629039144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- DVA RENAL HEALTHCARE INC
- Doing business as
- Newaygo County Dialysis
- Practice address
- 1317 W Main St
Fremont, MI 49412-1478 - Phone
- (231) 924-4535
- Fax
- (231) 924-4865
- NPI assigned
- Apr 1, 2006
- Last updated
- Feb 6, 2024
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | NU | Primary |
Addresses
Primary practice location
1317 W Main St
Fremont, MI 49412-1478
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4514
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4511180 | Medicaid | MI |
Other names 1
- Newaygo County Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030318000014 | MI | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 0840107611 | Practice locations: Fremont, MI |
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita Newaygo County Dialysis
- Overall star rating
- Ownership
- Profit
- Certified
- May 21, 2003
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 14
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 NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D1010425 | Newaygo County Dialysis | Certificate of waiver | Mar 12, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Dva Renal Healthcare Inc
Organizations with this tax ID in the same state 3
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba Romulus Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Romulus, MI
- NPI 1467414706
-
dba Muskegon Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Muskegon, MI
- NPI 1649231168
-
dba Ludington Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Ludington, MI
- NPI 1760443279
Locations
1317 W Main St
Fremont, MI 49412
Phone (231) 924-4535
Practitioners & affiliated clinicians
Affiliated clinicians 4
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": "1143849600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1707177600000",
"number": "1629039144",
"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",
"telephone_number": "615-320-4514",
"fax_number": "866-594-9961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1317 W MAIN ST",
"city": "FREMONT",
"state": "MI",
"postal_code": "494121478",
"telephone_number": "231-924-4535",
"fax_number": "231-924-4865"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DVA RENAL HEALTHCARE INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-01",
"last_updated": "2024-02-06",
"certification_date": "2024-02-06",
"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": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4511180",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Newaygo County Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Newaygo County Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fremont, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; 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.