Buckhorn Dialysis LLC

Primary specialty

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

Legal business name

BUCKHORN DIALYSIS LLC

Practice address

468 Chancellor Ave
Ste WS-3
Irvington, NJ 07111-4001

Phone

(973) 373-0294

Fax

(973) 371-1595

NPI assigned

Mar 1, 2018

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

• Irvington Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Listed as

DaVita Irvington DialysisCCN 312683

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Jun 25, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

19

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 3

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

• Dva Healthcare Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pearsall, TX
  • NPI 1194789859

  Member Of

  NPD member
• Isd Renal Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Canton, OH
  • NPI 1629596267

  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 6

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

• Andrew O Baddoo, M.D.

  • Internal Medicine Physician
  • West Orange, NJ
  • NPI 1881653608

  Dialysis facility

  Care Compare affiliation Name & address match
• Craig Russell Goldstein, DOMD

  • Nephrology Physician
  • West Orange, NJ
  • NPI 1700973203

  Dialysis facility

  Care Compare affiliation Name & address match
• Padmaja Kodali, MD

  • Nephrology Physician
  • Maplewood, NJ
  • NPI 1790747764

  Dialysis facility

  Care Compare affiliation Name & address match
• Segun V Simon, MD

  • Nephrology Physician
  • Maplewood, NJ
  • NPI 1194956490

  Dialysis facility

  Care Compare affiliation Name & address match
• Kundana Thimmanagari

  • Nephrology Physician
  • West Orange, NJ
  • NPI 1306498167

  Dialysis facility

  Care Compare affiliation Name & address match
• Mayuri Vijay-Sharma, MD

  • Nephrology Physician
  • West Orange, NJ
  • NPI 1326236308

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1689176141",
    "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": "468 CHANCELLOR AVE",
            "address_2": "STE WS-3",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071114001",
            "telephone_number": "973-373-0294",
            "fax_number": "973-371-1595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKHORN DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "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": "0638200",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Irvington Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Irvington Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph Alphonso Brown, DDS
• Kimberly M Brown, OD
• Leslie De'Shay Brown
• Patricia Jeffries Brown, MD
• Senetra Brown
• John Allen Buschner, CPRS
• Nahndi Bush, M.D.
• Naimah Calloway, M.A., CCC-SLP
• Camp Drugs Inc
• Jodi-Ann Janelle Campbell, RN

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Irvington, NJ
• Providers in Irvington, NJ by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; 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.