NPIMap

Organization Active NPI

Independent Dialysis Foundation, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Baltimore, MD
National Provider Identifier
1639187651
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E2515R Issued in MD
Legal business name
INDEPENDENT DIALYSIS FOUNDATION, INC
Practice address
840 Hollins St
Baltimore, MD 21201-1024
Phone
(410) 468-0900
Fax
(410) 468-0911
NPI assigned
Aug 4, 2006
Last updated
Jul 17, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
INDEPENDENT DIALYSIS FOUNDATION, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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

Authorized official

Name
Zeke Ayele
Title
Director of Information Systems
Phone
(410) 468-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X E2515R MD Primary

Addresses

Primary practice location

840 Hollins St
Baltimore, MD 21201-1024

Mailing address

840 Hollins St
Baltimore, MD 21201-1024
Phone (410) 468-0900

Other identifiers 4

IdentifierTypeStateIssuer
01689292MedicaidPA
0005759000MedicaidWV
PS1OtherMDFEP
590076-01OtherMDCAREFIRST

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071203000276 MD Part A Provider - End-Stage Renal Disease Facility (ESRD) 7719958503 Practice locations: Baltimore, MD

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Independent Dialysis Foundation Inc7 organizations share this tax ID, including this one
Part of
Independent Dialysis Foundation Inc

Other organizations with this tax ID 6

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

840 Hollins St
Baltimore, MD 21201
Phone (410) 468-0900

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1639187651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 HOLLINS ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011024",
            "telephone_number": "410-468-0900",
            "fax_number": "410-468-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 HOLLINS ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011024",
            "telephone_number": "410-468-0900",
            "fax_number": "410-468-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT DIALYSIS FOUNDATION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDEPENDENT DIALYSIS FOUNDATION, INC",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "AYELE",
        "authorized_official_first_name": "ZEKE",
        "authorized_official_title_or_position": "DIRECTOR OF INFORMATION SYSTEMS",
        "authorized_official_telephone_number": "410-468-0900"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MD",
            "license": "E2515R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01689292",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005759000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEP",
            "identifier": "PS1",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "590076-01",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.