Bullock Dialysis LLC

Primary specialty

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

Legal business name

BULLOCK DIALYSIS LLC

Practice address

2290 Ferguson Rd
Cincinnati, OH 45238

Phone

(513) 347-3626

Fax

(513) 347-2680

NPI assigned

Nov 22, 2019

Organization subpart

Yes

Parent organization

DAVITA INCAs reported in NPPES

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

Addresses

Other names 1

• Queen City Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

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

• Bullock Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Loveland, OH
  • NPI 1225549942

  7719244185

  Same PAC ID
• Bullock Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hamilton, OH
  • NPI 1396200887

  7719244185

  Same PAC ID
• Bullock Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fairfield, OH
  • NPI 1477018810

  7719244185

  Same PAC ID

Listed as

DaVita Queen City DialysisCCN 362894

Overall star rating

1.0 of 5

Ownership

Profit

Certified

May 6, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

17

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

CLIA laboratory certificates

Tax ID family

Bullock Dialysis LLC4 organizations share this tax ID, including this one

Part of

Davita Inc

Other organizations with this tax ID 3

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

• Bullock Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Loveland, OH
  • NPI 1225549942
  NPD tax ID
• Bullock Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hamilton, OH
  • NPI 1396200887
  NPD tax ID
• Bullock Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fairfield, OH
  • NPI 1477018810
  NPD tax ID

Member of 2

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

• The Good Samaritan Hospital of Cincinnati, Ohio

  • General Acute Care Hospital
  • Cincinnati, OH
  • NPI 1851904445

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockfrd, IL
  • NPI 1154997591

  Member Of

  NPD member

Locations

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Amir Izhar, M.D.

  • Nephrology Physician
  • Cincinnati, OH
  • NPI 1154361947

  Dialysis facility

  Care Compare affiliation Name & address match
• R Geoffrey Motz, MD

  • Nephrology Physician
  • Cincinnati, OH
  • NPI 1851787634

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756857600000",
    "number": "1639715808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "2290 FERGUSON RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45238",
            "telephone_number": "513-347-3626",
            "fax_number": "513-347-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULLOCK DIALYSIS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAVITA INC",
        "enumeration_date": "2019-11-22",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Queen City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Queen City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Newton H Bullard, MD
• Andrew Ross Buller, DPT
• Christina Buller, LISW, LCSW
• Rebecca Buller, FNP
• Bullkat Residential Solutions and Protective Services LLC
• Bridget Bullock
• Crystal Dawn Bullock, RT(R)(T)
• Diamond N Bullock
• Jennifer Bullock, M.ED., ED.S
• Martisa Bullock

• All providers in Cincinnati, OH
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; 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.