Physicians Choice Dialysis of Midwest City LLC

Primary specialty

Renal Dialysis TechnicianTaxonomy code 2472R0900X

Legal business name

PHYSICIANS CHOICE DIALYSIS OF MIDWEST CITY LLC

Practice address

3200 SE 29TH Street
Del City, OK 73115

Phone

(610) 495-8900

NPI assigned

Oct 6, 2020

Last updated

Jan 5, 2021By 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

Kelly Smith

Title

Director, Contracts

Phone

(302) 290-7408

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Listed as

Physicians Choice Dialysis of Midwest CityCCN 372617

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Oct 15, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

20

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.

• Lukas Haragsim, MD

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1396713541
  NPD (past)

Affiliated clinicians 4

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

• Lamia Amin Ahmad Abughazaleh, MD

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1477158533

  Dialysis facility

  Care Compare affiliation Name & address match
• Fazal Akbar Ali, MD

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1003956285

  Dialysis facility

  Care Compare affiliation Name & address match
• Ahmad Bilal, MD

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1609030345

  Dialysis facility

  Care Compare affiliation Name & address match
• Tariq Asadullah Khan, M.D.

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1396804662

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1639776222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 COMMERCE CT STE 104",
            "city": "POTTSTOWN",
            "state": "PA",
            "postal_code": "194643483",
            "telephone_number": "302-290-7408",
            "fax_number": "610-495-8652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 SE 29TH STREET",
            "city": "DEL CITY",
            "state": "OK",
            "postal_code": "73115",
            "telephone_number": "610-495-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS CHOICE DIALYSIS OF MIDWEST CITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DIRECTOR, CONTRACTS",
        "authorized_official_telephone_number": "302-290-7408"
    },
    "taxonomies": [
        {
            "code": "2472R0900X",
            "taxonomy_group": "",
            "desc": "Technician, Other, Renal Dialysis",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peace of Mind Pediatrics PLLC
• Janet Pennanen
• Emma K Perez, COTA/L
• Jordan Permaul, APRN CNP
• Fontella Phillips-Reid, HOMEHEALTH, CNA
• Tre Celeste Pickens
• Pinnacle Counseling Services
• Adam L Potorff, DDS
• Benny L Potter, DDS
• Premise Health of Oklahoma Medical, P.C (Premise Health - Del City)

• Other Technician in Del City, OK
• Providers in Del City, OK by specialty
• Other Technician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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.