Kobuk Dialysis LLC

Primary specialty

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

Legal business name

KOBUK DIALYSIS LLC

Practice address

1005 Pennsylvania Ave Ste 101
Ottumwa, IA 52501-6408

Phone

(641) 682-1531

Fax

(641) 682-0794

NPI assigned

Jan 10, 2013

Organization subpart

No

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 identifiers 1

Other names 1

• Ottumwa Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Listed as

DaVita Ottumwa DialysisCCN 162560

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Oct 16, 2015

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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

CLIA laboratory certificates

Member of 1

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

• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bourbonnais, IL
  • NPI 1073675138

  Member Of

  NPD member

Affiliated clinicians 2

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

• Jashim U Ahmed, MD

  • Internal Medicine Physician
  • Ottumwa, IA
  • NPI 1538145784

  Dialysis facility

  Care Compare affiliation Name & address match
• Ivy Reyes Melgarejo

  • Nephrology Physician
  • Des Moines, IA
  • NPI 1518349992

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1357776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1649517673",
    "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": "1005 PENNSYLVANIA AVE STE 101",
            "city": "OTTUMWA",
            "state": "IA",
            "postal_code": "525016408",
            "telephone_number": "641-682-1531",
            "fax_number": "641-682-0794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOBUK DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-10",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649517673",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ottumwa Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ottumwa Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberley S Kelly, LMHC, LMSW, IADC
• Jacy L Kennedy, ARNP
• Scott Byron King, DPM
• Bekki Jane Klodt, LMHC, NCC
• Tina Marie Knight
• Amy Kumagai, D.O.
• La Speech Therapy PC
• Lonnie Lee Lanferman, DO
• Billie June Lanham, FNP-C
• Amanda Le Larkin, LISW

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ottumwa, IA
• Providers in Ottumwa, IA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.