Randolph Dialysis LLC

Primary specialty

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

Legal business name

RANDOLPH DIALYSIS LLC

Doing business as

Three Rivers Dialysis

Practice address

6721 Old Trail Rd
Ste 100
Fort Wayne, IN 46809-2655

Phone

(260) 478-8582

Fax

(260) 478-8566

NPI assigned

Feb 19, 2014

Organization subpart

No

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

Authorized official

Name

John Winstel

Title

Chief Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Three Rivers Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

DaVita Three Rivers DialysisCCN 152676

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Nov 2, 2016

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 2

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

• Nephrology Associates of Northern Indiana, Inc

  • Nephrology Physician
  • Fort Wayne, IN
  • NPI 1578505814

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Locations

Affiliated clinicians 2

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

• Garima Gupta, MD

  • Nephrology Physician
  • Fort Wayne, IN
  • NPI 1073729125

  Dialysis facility

  Care Compare affiliation Name & address match
• Kiran Babu Mandya Chikkalingaiah, M.D

  • Nephrology Physician
  • Fort Wayne, IN
  • NPI 1598982712

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1659796233",
    "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",
            "telephone_number": "615-320-4514",
            "fax_number": "866-594-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6721 OLD TRAIL RD",
            "address_2": "STE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468092655",
            "telephone_number": "260-478-8582",
            "fax_number": "260-478-8566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-19",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "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": "300009689A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Three Rivers Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Randall
• Stacy Randall
• Brooke Randol, MSN, RN, AGCNS-BC
• Colette Randol, MSW
• Crista Randol, FNP-C
• Geoffrey M Randolph, MD
• Jesse Marie Randolph
• Armando Rangel Jr., R.D.
• Rachel L Rankin, RBT
• Adrienne Ranly

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; 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.