Etowah Dialysis LLC

Primary specialty

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

Legal business name

ETOWAH DIALYSIS LLC

Doing business as

St. Luke's Macungie Dialysis

Practice address

2550 Route 100
Ste 2
Macungie, PA 18062-9600

Phone

(610) 336-8350

Fax

(610) 336-8354

NPI assigned

Mar 18, 2019

Last updated

Jul 16, 2025By 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

Samuel Wey

Title

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St. Luke's Macungie Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 6

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

• Etowah Dialysis LLC

  dba St Luke's Tamaqua Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tamaqua, PA
  • NPI 1033687413

  2567699085

  Same PAC ID
• Etowah Dialysis LLC

  dba St Lukes Home Training

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Allentown, PA
  • NPI 1376909515

  2567699085

  Same PAC ID
• Etowah Dialysis LLC

  dba St. Luke's Anderson Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Easton, PA
  • NPI 1386345361

  2567699085

  Same PAC ID
• Etowah Dialysis LLC

  dba St Lukes Bethlehem Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bethlehem, PA
  • NPI 1457787715

  2567699085

  Same PAC ID
• Etowah Dialysis LLC

  dba St Lukes Whitehall Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Whitehall, PA
  • NPI 1770948838

  2567699085

  Same PAC ID
• Etowah Dialysis LLC

  dba St Lukes Allentown Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Allentown, PA
  • NPI 1790111060

  2567699085

  Same PAC ID

Listed as

DaVita St. Luke's Macungie DialysisCCN 392889

Ownership

Profit

Certified

Aug 14, 2019

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

Tax ID family

Etowah Dialysis LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

• Etowah Dialysis LLC

  dba St Luke's Tamaqua Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tamaqua, PA
  • NPI 1033687413
  NPD tax ID
• Etowah Dialysis LLC

  dba St Lukes Home Training

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Allentown, PA
  • NPI 1376909515
  NPD tax ID
• Etowah Dialysis LLC

  dba St. Luke's Anderson Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Easton, PA
  • NPI 1386345361
  NPD tax ID
• Etowah Dialysis LLC

  dba St Lukes Bethlehem Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bethlehem, PA
  • NPI 1457787715
  NPD tax ID
• Etowah Dialysis LLC

  dba St Lukes Whitehall Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Whitehall, PA
  • NPI 1770948838
  NPD tax ID
• Etowah Dialysis LLC

  dba St Lukes Allentown Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Allentown, PA
  • NPI 1790111060
  NPD tax ID

Member of 1

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

• Total Renal Care, Inc.

  dba Bountiful Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bountiful, UT
  • NPI 1184387516

  Member Of

  NPD member

Affiliated clinicians 1

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

• Dhaval Sureja, M.D.

  • Nephrology Physician
  • Allentown, PA
  • NPI 1033434436

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1659830800",
    "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": "2550 ROUTE 100",
            "address_2": "STE 2",
            "city": "MACUNGIE",
            "state": "PA",
            "postal_code": "180629600",
            "telephone_number": "610-336-8350",
            "fax_number": "610-336-8354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETOWAH DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-18",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029243170008",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Macungie Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Luke's Macungie Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marina Domatova, MD
• Alyssa Dunleavy, DPT
• East Penn Audiology LLC
• Bryce Ebersole
• Amany Ekladioss
• Everyday Home Care Clarks Summit
• Faith Home Health Care, Inc.
• Joseph Farabaugh, PT, DPT
• Patricia Wallace Farley, RN
• Claudia Ferran, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Macungie, PA
• Providers in Macungie, PA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.