Dialysuites Bartram Park LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

DIALYSUITES BARTRAM PARK LLC

Practice address

13241 Bartram Park Blvd Unit 305
Jacksonville, FL 32258-5236

Phone

(904) 566-2951

NPI assigned

Feb 8, 2022

Last updated

Feb 8, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Danae C Philliips Munjal

Title

Ceo

Phone

(904) 566-2951

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sandeep Munjal, MD

  • Nephrology Physician
  • Jacksonville, FL
  • NPI 1588687735
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644278400000",
    "number": "1629722707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD UNIT 305",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585236",
            "telephone_number": "904-566-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD UNIT 305",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585236",
            "telephone_number": "904-566-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSUITES BARTRAM PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-08",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A",
        "authorized_official_last_name": "PHILLIIPS MUNJAL",
        "authorized_official_first_name": "DANAE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-566-2951",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Diamond Supported Living Services, Inc.
• Andi Diamond, PA-C
• Jane Diamond, ARNP
• Chritian Cynthia Enguerra Diana, APRN-BC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; 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.