Dialysis Clinic Inc.

Primary specialty

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

License

07930 Issued in AL

Legal business name

DIALYSIS CLINIC INC.

Practice address

3861 Salem Rd.
Enterprise, AL 36330-7335

Phone

(334) 347-8233

Fax

(334) 347-3814

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Authorized official

Name

Donovan Schultz

Title

President

Phone

(615) 327-3061

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Renal Hypertension Clinic

  • Nephrology Physician
  • Dothan, AL
  • NPI 1063526663

  O20060104000572

  Same enrollment

Listed as

Dci EnterpriseCCN 012527

Overall star rating

3.0 of 5

Ownership

Non-profit

Certified

Jul 4, 1986

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Dialysis Clinic, Inc.

Dialysis stations

26

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

Dialysis Clinic Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Renal Hypertension Clinic

  • Nephrology Physician
  • Dothan, AL
  • NPI 1063526663
  NPD tax ID

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Practitioners 3

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.

• Ravindranath V. Kantamneni, M.D.

  • Nephrology Physician
  • Dothan, AL
  • NPI 1053361576
  NPD
• Jennifer Smith Kirk, CRNP

  • Family Nurse Practitioner
  • Dothan, AL
  • NPI 1033363189
  NPD
• Venkat R Nimmagadda, M.D.

  • Nephrology Physician
  • Dothan, AL
  • NPI 1043267917
  NPD

Affiliated clinicians 1

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

• Nowoghomwenma Charles Ibie, MD

  • Nephrology Physician
  • Dothan, AL
  • NPI 1073742953

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1669405049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 COLUMBIA HWY",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363035434",
            "telephone_number": "334-793-3519",
            "fax_number": "334-793-6932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3861 SALEM RD.",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363307335",
            "telephone_number": "334-347-8233",
            "fax_number": "334-347-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DONOVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-327-3061"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "AL",
            "license": "07930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DIA2527D",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyler Delaney, RBT
• Dermatology Associates of Dothan, LLC
• Douglas W Devore, O.D.
• Andrea Darlene S. Dezso, LLISW
• Dialogue Therapy Services, LLC
• Kathlyn Diefenderfer, MD
• Todd Diefenderfer, PTA
• Dobbs Eye Clinic P.a.
• James A Dobbs, O.D.
• Brandy Donaldson, PHARM. D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Enterprise, AL
• Providers in Enterprise, AL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.