Dsi Macon, LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Gray, GA
NPI 1629464797 · NPPES record last updated Feb 15, 2016
Key facts
- NPI
- 1629464797
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- DSI MACON, LLC
- Practice address
- 1002 Boulder Dr
Gray, GA 31032-6140 - Phone
- (478) 986-3066
- Fax
- (478) 986-3114
- NPI assigned
- Apr 15, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- U.S. RENAL CARE, INC.
Authorized official
- Name
- Thomas L. Weinberg
- Title
- Authorized Official
- Phone
- (214) 736-2700
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 5
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1061298 | Dsi Macon, LLC | Certificate of waiver | Nov 14, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150619000745 | GA | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 2264743467 | Practice locations: Gray, GA |
National Provider Directory
- Tax ID family
- Dsi Macon LLC
- Part of
- US Renal Care Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
1002 Boulder Dr
Gray, GA 31032-6140
Mailing address
424 Church St
Suite 1900
Nashville, TN 37219-2301
Phone (615) 777-8200
Other names
- U.S. Renal Care Gray Dialysis
Other providers in Gray, GA
- Samantha Craft
- Maria Flordesol Abuloc Culpa-Bondal
- Terri Brown Cunningham
- Sabine Doirin
- Ashley Danielle Douglas
- Angela Montgomery Eells
- Tory Kirsten Etheridge
- Natalie F Evans
- Ga Pain and Behavioral Medicine Inc.
- Marci Gallagher
All providers in Gray, GA · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.