NPIMap

Organization Active NPI

Sprague Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bridgeton, NJ
National Provider Identifier
1639613649
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
25050 Issued in NJ
Legal business name
SPRAGUE DIALYSIS LLC
Practice address
333 Irving Ave
Bridgeton, NJ 08302-2123
Phone
(856) 575-4200
Fax
(856) 453-0174
NPI assigned
Dec 9, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

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

Authorized official

Name
Samuel Wey
Title
VP, Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 25050 NJ Primary

Addresses

Primary practice location

333 Irving Ave
Bridgeton, NJ 08302-2123

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0598917MedicaidNJ

Other names 1

  • Bridgeton Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170124000638 NJ Part A Provider - End-Stage Renal Disease Facility (ESRD) 6608158894 Practice locations: Bridgeton, NJ

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Bridgeton Dialysis4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 5

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1481241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1639613649",
    "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": "333 IRVING AVE",
            "city": "BRIDGETON",
            "state": "NJ",
            "postal_code": "083022123",
            "telephone_number": "856-575-4200",
            "fax_number": "856-453-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRAGUE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-09",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": "NJ",
            "license": "25050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0598917",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgeton Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bridgeton Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; 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.